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$50 CARE ENOUGH
TO SHARE $50
Every person that you refer
receives this $50 certificate
to use on their next dental visit.
When they redeem it, you receive
$25 off your next visit, or a certificate for dinner on us!!! (your choice!)
_______________________________
New Patient's Name
Referred by: ____________________________
Address: _______________________________
________________________________________
I would like:
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____
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$25 Dental Certificate
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____
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$25 Restaurant Certificate
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