To Whom It May Concern:
I
give authorization for (previous dentist name)
to release all dental records for Harmony Dental Studio for the following patients:
Please email digital x-rays to the email provided above and provide the following information:
Thank your for your co-operation. If you have any questions or concerns, please do not hesitate to contact us via our office number or email.
Sincerely,
Dr. Behnaz Haghighizadeh
Dr. Mahdi Ghadimkhani
Email: info@harmonydentalstudio.ca
3175 Rutherford Rd Unit 63, Concord, Ont L4K 5Y6, (289) 444-0461
