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Capitol Hill Dental Clinic
Dr. William Wong and Dr. Cindy Fong
Creating Beautiful Smiles

FINANCIAL POLICY AND CREDIT CARD AUTHORIZATION

Please print and fill out this form then bring it with you at your Dental Appointment. If you don't have access on the printer, please let us know ahead of time so we can have one ready for you at the Front Desk on the day of your appointment. Thank you!

FINANCIAL POLICY AND CREDIT CARD AUTHORIZATION FORM


Testimonials

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