Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Enter the date in the designated field at the top of the form. Use the format ____/____/____.
3. In the 'Patient Name(s)' section, provide the full names of the patient or patients for whom the X-ray is requested.
4. If the person requesting the X-ray is different from the patient(s), fill in the 'Requested by' field with their name.
5. Next, specify the relationship to the patient in the corresponding field to clarify the connection.
6. In the section titled 'X-ray(s) to be sent to', confirm that the details for Jennifer Sokolosky D.M.D. are correctly listed, including the address.
7. Provide authorization by writing your name in the space provided beneath 'I, _____, authorize the release of the x-rays requested.'
8. Lastly, sign the form in the 'Signature' field to affirm your authorization.
9. Once you have completed all fields, be sure to save your changes. You can also choose to download, print, or share the form as needed.

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