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SCHOOL HEALTH SERVICFS

WAPPIN GERS CEh'J ICAL SCHOOL DISJ RICT


SCI-IOOL

DENTAL HE.ALTIJ CERTIFICATE

Student

Date of C.omprehensive Dental Examination:

to I reaiment Required reatment in k regress Treatment Completed

Student is in fit conditi on of dental health to per ink I school attendance: \ es

S i mature of Dentist

Name of Dentist

Address r›f Dentist

Telephone Number of Dentist

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