I authorize the release of records relevant to dental treatment and request that they be transferred to the following office.
Dr. Venetia Laganis, D.D.S., M.S.
7767 Elm Creek Blvd., Suite 110
Maple Grove, MN 55369
Phone (763) 420-2610
Fax (763) 494-4390
Please list name(s) and date of birth for ALL patient whose records need to be transferred: