Download -  · 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

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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