X-Ray Release Form

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Dr. Manisha Chauhan, DDS

2160, 4 Royal Vista Way NW

Calgary, AB T3R 0N2

(587) 327-9990

[email protected]

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Please forward any radiographs and/or photographs taken to Dr Manisha Chauhan.
Email : [email protected]
I hereby give you consent to release all my dental records to Dr. Chauhan at Avyan Family Dental.
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