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1401 O'Connor Dr. Unit 5,
East York, ON M4B 2V5, Canada
Phone: 905-201-7001
Email: oconnordentaloffice@gmail.com
Canadian Dental Care Plan (CDCP) Eligable Seniors Book Here!
We Now Provide Services To IFHP Recipients.
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DENTAL RECORD RELEASE FORM
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Initials
Authorization for Release of Dental Records and Radiographs. I hereby authorize the release of my / my family’s dental radiographs to O'Connor Dentistry. In addition please note date of last recall and any additional information that would be beneficial to my dental care. Please forward at your earliest convenience.
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+1
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