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563. 5157 Address 6220 Peters Creek Road NW or 490 South Main Street or 4370 Starkey Road Suite C City State Roanoke VA 24019 Rocky Mount VA 24151 E-mail info roanokevalleyortho. Dr. David L. Jones Dr. Maston R. McCorkle 540. 563. 1640 info roanokevalleyortho. com Roanoke Valley Orthodontics ACKNOWLEDGMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES You May Refuse to Sign This Acknowledgment dated Sept 23rd 2013 I have received a copy of this Please Print Patient Parent/Legal Guardian if...

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