Forms - Page 2

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No. 112 Daily Record - Complete record of production, collections, discounts, and accounts receivable. Space for recording new/recall patients.  Daily and month-to-date.  For Binder No. 118.

8-1/2 x 11     Pkg: 200
1/$21.72   3/$21.42 ea    6/$21.12 ea

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No. 113 Monthly Disbursement Record - Simple entry from check book.  Disburse into one of 16 columns for tax records.  For Binder No. 118.

8-1/2 x 11
1/$19.08     3/$18.99 ea

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No. 114 Yearly Summary and Analysis - Complete record of production, collection, expenses, new patients, recall patients by month and year-to-date.  For Binder No. 118.

8-1/2 x 11       Pkg: 3
1/$2.21     3/$2.06 ea

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No. 115S Appointment Book - Spiral bound book, spacious, easy to read.  Hours 8:00 to 6:00, week-at-a-glance with 15-minute intervals.  Name and service columns.  

11 x 12-5/8           Pkg: 1 year
$22.95   

No. 115B Appointment Book Sheets - Loose sheet version of the 115S book.

$16.99/pk (1 yr of sheets)

 

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No. 116 Patient Ledger Card - White heavyweight index paper. Date, service, charge, payment, and balance columns. Manual system.

6 x 9            Pkg: 200
1/$18.24     3/$17.24 ea    6/$16.94 ea

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No. 117D Appointment Book Binder - Same as No. 117 except for use by two doctors.

11-3/4 x 20-1/8        Pkg. 1
1/$17.25     2/$16.50 ea

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No. 120 Hygienist Appointment Book - Week-at-a-glance, 15-minute intervals, convenient spiral bound.  Complete with sheets for one year.

7 x 10          Pkg: 1
1/$17.99     2+/$17.00 ea

No. 120A Hygienist Appointment Book - Same as No. 120 but with 10-minute intervals.   Yellow Cover.  

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