I’m a patient at Kennet Orthodontics and I will be entered into a drawing for a gift card of my choice for seeing you for teeth cleanings on a regular basis during my orthodontic care. Patient Name: Dental Office Dentist /Hygienist Signature Date www.kennetortho.com 19991 Hall Road, Ste. 101, Macomb, MI 48044 (586) 416-4455 I’m a patient at Kennet Orthodontics and I will be entered into a drawing for a gift card of my choice for seeing you for teeth cleanings on a regular basis during my orthodontic care. Patient Name: Dental Office Dentist /Hygienist Signature Date www.kennetortho.com 19991 Hall Road, Ste. 101, Macomb, MI 48044 (586) 416-4455 I’m a patient at Kennet Orthodontics and I will be entered into a drawing for a gift card of my choice for seeing you for teeth cleanings on a regular basis during my orthodontic care. Patient Name: Dental Office Dentist /Hygienist Signature Date www.kennetortho.com 19991 Hall Road, Ste. 101, Macomb, MI 48044 (586) 416-4455
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