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(877) 721-2001

417 University St. • Suite 1
Trinidad, CO 81082

Patient-Dentist Trust and Comfort Contract

You may type in your answers and then print the contract for your records at the bottom.

Please fill out the following form to help us make you comfortable and take better care of you. After completing it, sign the form. We’ll sign it as well and agree to do our best at addressing each relevant point that you need for your comfort.

If you want to print the completed page for your records, you must do so BEFORE you send us the form.