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Today's Date
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DD slash MM slash YYYY
Previous Dental Office
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Previous Dental Office's Phone Number
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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
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About
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Expand
Our Office
Our Team
Expand child menu
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Dr. Jeff Bullock
Dr. Do Hyun Sung
Services
Expand child menu
Expand
General Dentistry
Expand child menu
Expand
Exam
Hygiene
Fillings
Sedation Dentistry
Extractions
Root Canal
TMJ Treatment
Teeth Whitening
Restorative Dentistry
Expand child menu
Expand
Veneers
Crowns
Bridges
Implants
Children’s Dentistry
Periodontal Health
Emergency Dentistry
Orthodontics
Expand child menu
Expand
30 Second Smile Test
Braces
Invisalign
Expand child menu
Expand
Invisalign vs Braces
Calgary Ortho Costs
Contact Us
Expand child menu
Expand
Our Nearby Location
Our Forms
Expand child menu
Expand
New Patient Form
X-Ray Release Form
Book Now
