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AUTHORIZATION TO RELEASE DENTAL INFORMATION (THE EXECUTION OF THIS FORM DOES NOT AUTHORIZE THE RELEASE OF INFORMATION OTHER THAN THE TERMS SPECIFICALLY DESCRIBED BELOW.) NAME OF PATIENT: DOB: ADDITIONAL
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Bliss Family Dental is a website for a dental clinic.
The dental clinic owners or administrators are required to maintain and update the website.
The website can be filled out with information about the dental services offered, contact information, and any promotions.
The purpose of the website is to provide information about the dental clinic and attract potential customers.
Information about the dental services, staff, location, and contact details must be reported on the website.
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