Dental Record Release

Linda Robinson Dental
380 Russell, Street Suite 101
Hadley, MA 01035
413 587-0888 phone/ 413 587-0808 fax
drrobinson@lindarobinsondental.com

Hereby Authorize The Doctors Of,
To release my Dental Records by email, including X-RAYS AND CHART NOTES to drrobinson@lindarobinsondental.com
 
Linda Robinson Dental
380 Russell Street, Suite 101
Hadley, MA 01035
Phone # 413 587-0888
Fax # 413 587-0808