Records Release

Records Release

Records Release
I hereby authorize Dr.*
to release my x-rays to: Jason P. Tosto, DMD
Please enter previous dental office contact information
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________________________________________

PLEASE EMAIL X-RAYS TO: schedule@2nd-opiniondental.com

If you have any questions or require further assistance, please feel free to contact our office.

Thank you,

Jason P. Tosto, DMD
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