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Get Dental Health of Rockland X-Ray Request and Release Form

To Patient: _______________________ Exam Date(s) Requested: ___________________________________________________ X-Ray(s) to be Sent/Faxed to: _______________________________________________ ________________________________________________________________________ I __________________________ authorize the release of the X-Rays(s) requested above. ________________________________________________________________________ Signature Date .

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The times of frightening complicated tax and legal documents are over. With US Legal Forms the procedure of filling out official documents is anxiety-free. The leading editor is already close at hand giving you a wide variety of beneficial instruments for completing a Dental Health of Rockland X-Ray Request and Release Form. These tips, along with the editor will assist you through the complete procedure.

  1. Click the orange Get Form option to start filling out.
  2. Turn on the Wizard mode in the top toolbar to have extra tips.
  3. Fill in each fillable field.
  4. Ensure that the details you add to the Dental Health of Rockland X-Ray Request and Release Form is up-to-date and correct.
  5. Indicate the date to the sample with the Date tool.
  6. Select the Sign tool and create a digital signature. Feel free to use three available choices; typing, drawing, or capturing one.
  7. Check once more every field has been filled in properly.
  8. Click Done in the top right corne to export the document. There are several choices for getting the doc. As an instant download, an attachment in an email or through the mail as a hard copy.

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