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Part 1: Dental Appointment Change

Questions 1–10

Complete the form below. Write ONE WORD AND/OR A NUMBER for each answer.

Dental Clinic – Update Form

Patient Details

  • Surname: 1 ……………
  • Home address: 16 2 …………… Road
  • Current appointment: 3 ……………
  • Reason for cancellation: attending a university 4 ……………
  • Membership level: 5 ……………
  • Medical notes: suffers from a frequent 6 ……………

Rescheduled Booking

  • New time: 7 ……………
  • Assigned to: Dr 8 ……………
  • Parking location: please use the 9 ……………
  • Payment option: pay via the clinic 10 ……………