Records Transfer Request

Tina P. Moses, DPM, PC

Please correct the errors described below.

I authorize the transfer of dental and medical records relevant to dental treatment, or copies of such, and request that they are transferred to:

Tina P. Moses, DMD, PC

1240 Augusta West Parkway

Augusta, GA 30909-1854

706-863-6262 (o)

706-863-6465 (f)

Email records to:

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