Forms - Cont.

Back   Back to Page 2  
Apptcard.gif (5796 bytes)

No. 124 Appointment Card - Economical. Can be used for 3 appointments.  24-hour cancellation notice.  Blue, green , yellow, white.

2 x 3          Pkg: 1000           
$55.80

Apptlist.gif (6186 bytes)

No. 126 Today's Appointment List - Use to keep those daily schedules posted.  Sheet shows name, time, and services. Requires carbon to make multiple copies.

5-7/8 x 9-3/8            Pkg: 200          
$10.84

No. 126A - Carbonless.  Same as No.126 but with 10-minute intervals.

No. 126C - Carbonless.  Same as No.126

Emplearn.gif (7531 bytes)

No. 127 Employee Earning & Withholding Records - One sheet per employee.  One year's record of salary, FICA, withholding, etc.  For Binder No. 118.

8-1/2 x 11        Pkg: 25          
$5.10

Legercd2.gif (5623 bytes)

No. 169 Patient Ledger Card - Buff NCR paper.  Complete information including date, first name, service, charge, payment, adjustment, balance, and previous balance columns.   Use with No. 171 Peg Board and No. 170 Daily Production and Collection Record.

Pkg: 200          
1/$24.96     3/$23.92 ea

Prodcoll.gif (6145 bytes)

No. 170 Daily Production and Collection Record - Includes standard charge, payment, discount columns plus record of new patients, recall patients, cases accepted, etc.   Use with No. 169 Ledger Card and No. 171 Peg Board.

Pkg: 100          
1/$17.91     3/$16.89

Pegboard.gif (2296 bytes)

No. 171 Peg Board - Small, lightweight.  Use with No.170 Daily Production and Collection Record, No. 169 Patient Ledger Card, No. 168/168P Dental Insurance Claim Form.  

10-1/2 x 11          Pkg: 1            
$15.00

History.gif (4492 bytes)

No. 193 Medical History Chart - A complete and comprehensive history on your patients.   Printed front and back. Padded.

8-1/2 x 11          Pkg: 1 pad (100 sheets)     
1/$18.66     3/$18.02 ea

Env1.gif (2709 bytes)

No. 110R Return Envelopes - Quality envelopes. Regular flap. Standard return remittance envelope.

Pkg: 500          
$50.10

Env2.gif (2231 bytes)

No. 111 Window Envelopes - Quality envelope, center position window.  Doctor's return adress printed in upper left corner.  Blue, green, yellow, or white.

3-5/8 x 6-1/2          Pkg: 500         
$41.25

Back   Back to Page 2  

 

 

©2003 Cooke and Associates
Home - About - Acrylics - Disposables - Forms - Gloves - Instruments - Lab Apparel - Labels & Rings - Office Supply - Disinfectants - Prophy Supplies - Tooth Lines - Cements and Varnishes
Email Us