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About
Our Office
Our Team
Dr. Jeff Bullock
Dr. Do Hyun Sung
Services
General Dentistry
Exam
Hygiene
Fillings
Sedation Dentistry
Extractions
Root Canal
TMJ Treatment
Teeth Whitening
Restorative Dentistry
Veneers
Crowns
Bridges
Implants
Children’s Dentistry
Periodontal Health
Emergency Dentistry
Orthodontics
30 Second Smile Test
Braces
Invisalign
Invisalign vs Braces
Calgary Ortho Costs
Contact Us
Our Nearby Location
Our Forms
New Patient Form
X-Ray Release Form
About
Our Office
Our Team
Dr. Jeff Bullock
Dr. Do Hyun Sung
Services
General Dentistry
Exam
Hygiene
Fillings
Sedation Dentistry
Extractions
Root Canal
TMJ Treatment
Teeth Whitening
Restorative Dentistry
Veneers
Crowns
Bridges
Implants
Children’s Dentistry
Periodontal Health
Emergency Dentistry
Orthodontics
30 Second Smile Test
Braces
Invisalign
Invisalign vs Braces
Calgary Ortho Costs
Contact Us
Our Nearby Location
Our Forms
New Patient Form
X-Ray Release Form
About
Our Office
Our Team
Dr. Jeff Bullock
Dr. Do Hyun Sung
Services
General Dentistry
Exam
Hygiene
Fillings
Sedation Dentistry
Extractions
Root Canal
TMJ Treatment
Teeth Whitening
Restorative Dentistry
Veneers
Crowns
Bridges
Implants
Children’s Dentistry
Periodontal Health
Emergency Dentistry
Orthodontics
30 Second Smile Test
Braces
Invisalign
Invisalign vs Braces
Calgary Ortho Costs
Contact Us
Our Nearby Location
Our Forms
New Patient Form
X-Ray Release Form
About
Our Office
Our Team
Dr. Jeff Bullock
Dr. Do Hyun Sung
Services
General Dentistry
Exam
Hygiene
Fillings
Sedation Dentistry
Extractions
Root Canal
TMJ Treatment
Teeth Whitening
Restorative Dentistry
Veneers
Crowns
Bridges
Implants
Children’s Dentistry
Periodontal Health
Emergency Dentistry
Orthodontics
30 Second Smile Test
Braces
Invisalign
Invisalign vs Braces
Calgary Ortho Costs
Contact Us
Our Nearby Location
Our Forms
New Patient Form
X-Ray Release Form
X-Ray Release Form
X-Ray Release Form
Today's Date
*
Previous Dental Office
*
Previous Dental Office's Phone Number
Consent
*
I hereby authorize the release
Of my family's dental radiographs from my previous dental clinic so that they can be transferred to Parkway Smiles Dental.
Panorex within the last 5 years
Bitewings within the last 2 years
Periapical radiographs within the last 2 years
Patient Name
*
First Name
Last Name
Signature
*
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