Medical Release Form

Pediatric & Adolescent Dentistry and Orthodontics

Please correct the errors described below.

In our continuing efforts to ensure the safety of our mutual patient, we request your response to our medical release form. Please provide us with the information and any suggestions or comments you may have. If you would like to discuss any particular aspect of the planned treatment, please call our office at (619) 440-5915 or Fax (619) 440-0605.

Dentist: Gary A. Olen, D.D.S., M.S., Inc. & Michael Maurer, D.D.S., M.S., Inc.

** Can the Local anesthetics be administered?

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