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Dr. Dhaval Thakkar DMD www. AlvinFamilyDentistry. com Email info alvinsmilestx. com 173 Tovrea Rd STE D Alvin TX 77511. Alvin Smiles Phone 281-824-4270 XRAY/MEDICAL RELEASE FORM I give authorization for to release my dental x-rays/medical notes to for my continued treatment. Date Patient Print Patient Sign OFFICE USE ONLY X-Rays/Medical Released Affordable and Quality Dental Care for the Entire Family.
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