F004 – Record of Treatment with payment column

F004 – Record of Treatment with payment column



Quantity Discounts - Order a quantity in the range below to receive the discount

Quantity Amount
2 to 3 $38.02
4 to 5 $37.83
6 or more $37.63


Describe treatment by date, tooth, surface and procedure. Room to include total documentation of all treatment information, medication, and important notes about the patient's behavior and attitude during treatment. Key features: Category headings assure consistent documentation, including fees charged, payment and balance. The Record of Treatment form is the most important of all patient chart documentation - ensure yours is the best.

Each package contains 200 sheets.

Additional information

Weight 3 lbs