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Securely Send a Picture or File
Send Pictures or Files Securely to Lindsey Dentistry PPLC
First Name
Last Name
Date Of Birth
Are You A New Patient?
Do You Have Dental Insurance?
Click below to upload a Photo or File. MOBILE DEVICES: You can take a picture with your phone and then upload from your photos.
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or drag files here
Comments: (ex. This is secondary Insurance, This insurance is for myself only)
Patient/Legal Guardian Signature
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Signature Pad
Date
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