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East Atlanta Family DentalAuthorization for Disclosure of Health InformationPatient Name:Date of Birth: Phone:Address:City: State: Zip:1. I authorize the use or disclosure of the above named individuals
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East Atlanta Family Dental is a dental clinic located in East Atlanta specializing in family dental care.
Patients who receive dental services from East Atlanta Family Dental are required to file their own dental records.
Patients can fill out their dental records at East Atlanta Family Dental clinic or request a copy of their records to be filled out.
The purpose of East Atlanta Family Dental is to provide quality dental care for families in the East Atlanta area.
Information such as patient's personal details, dental history, treatment provided, and billing information must be reported on East Atlanta Family Dental records.
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