INFANT PATIENT FORMS

Healthcare Provider Information

(Hippa)

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Medical Information Release

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Treatment Estimate

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Tongue / Lip Tie Patient

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CHILD/ADULT

PATIENT FORMS

Medical Information Release

All Intake (Child + Adult)

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HX Assessment (Child + Adult)

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Once you've filled out and completed the required forms, please save the file to your computer. Email completed forms to hello@untetheredttc.com