First Dental Visit
		Child's Name: ___________________________________________________________________ Age: ____________   M/F: _________    Sibling(s) Name_________________________________ Dentist's Name: __________________________________________________________________ Friend's Name:__________________________________________________________________ Chore Child Completes: ___________________________________________________________
	Ordering Information: Your Name: ___________________________________ Address: _____________________________________ City: _______________     State: _____    Zip: _______ Telephone: ___________________________________
			Please Send Completed Order Form and Payment to: April Joyce "Special Occasion Letters" Route 1 Box 51 Sprott, AL. 46779