Appointment check-in - Triax Dental - Special Needs and General Dentistry in Nashville, TN

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Please complete our appointment check-in form below. If you have any questions call us on (615) 348-1008.

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Patient name:*

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Patient date of birth:*

Did the patient take a pre-med prior to this appointment?*

If (yes) please inform medication name, dose and time:*

Driver/caregiver contact info:

Driver name:*

Use 'self' if you are driving

Driver phone number:*

Relationship to patient:

Ignore this field if you are the patient

Vehicle color:*

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Vehicle (make and model):*

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