Get Alvin Smiles 173 Tovrea Rd Alvin Tx 77511

Filling out the Alvin Smiles x-ray and medical release form online is a straightforward process. This guide will provide you with clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the form

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. In the first blank line, enter your full name where it states 'I, ________________ give authorization for ______________'. This indicates who is giving the authorization.
3. In the next blank line, write the name of the dental practice or healthcare provider that will be releasing your dental x-rays/medical notes.
4. On the line that follows, fill in the name of the individual or entity that will receive your dental x-rays/medical notes.
5. Complete the date section by entering the current date, ensuring your authorization is timely.
6. Print your name in the designated area labeled 'Patient – Print' to indicate that you are the patient providing authorization.
7. Sign your name in the area marked 'Patient – Sign' to formally acknowledge your consent.
8. After completing the form, make sure to review all entries for accuracy. Save your changes.
9. Once verified, you can download, print, or share the completed form as needed.

Complete your x-ray and medical release form online today to ensure your continued dental care.