· after explanation by the doctor, i hcreby authorize the performance of dental services upon the...

5

Upload: others

Post on 29-Sep-2020

2 views

Category:

Documents


0 download

TRANSCRIPT

Page 1:  · After explanation by the doctor, I hcreby authorize the performance of dental services upon the above named patients and whatever procedures that the judgement of the doctor may
Page 2:  · After explanation by the doctor, I hcreby authorize the performance of dental services upon the above named patients and whatever procedures that the judgement of the doctor may
Page 3:  · After explanation by the doctor, I hcreby authorize the performance of dental services upon the above named patients and whatever procedures that the judgement of the doctor may
Page 4:  · After explanation by the doctor, I hcreby authorize the performance of dental services upon the above named patients and whatever procedures that the judgement of the doctor may
Page 5:  · After explanation by the doctor, I hcreby authorize the performance of dental services upon the above named patients and whatever procedures that the judgement of the doctor may