| Paper Color(s) | Blue |
| Finish | Label Stock |
| Global Product Type | Forms-Medical Admissions |
| Form Size | 8.5 x 11.63 |
| Forms Per Page | 1 |
| Number of Entry Lines | 23 |
| Form Quantity | 125 |
| Sheet Size | 8.5 x 11.63 |
| Principal Heading(s) | Date; Please Print Name; Arrival Time; Appt. Time; Appointment With; New Patient; Any Changes Since Last Visit |
| Number of Columns | 6 |
| Layout | One Form per Sheet |
| Numbering | Preprinted Entry Lines |
| Copy Types | Two-Part Carbon |
| Total Number of Entries per Book | 2,875 |
| Print and Ruling Color(s) | Black |
| Numbering Color(s) | Black |
| Pre-Consumer Recycled Content Percent | 0% |
| Post-Consumer Recycled Content Percent | 0% |
| Total Recycled Content Percent | 0% |