Brit Phillips, DDS, PA
Release Information FROM:
Organization Name: Brit Phillips DDS, PAAddress: 6610 Bryant Irvin, Suite 100Fort Worth, Texas 76132Release Information TO:
By signing this Authorization, I authorize my Health Care Provider to disclose my protected health information
Your information will be encrypted.
Your browser does not support capabilities required for electronic signatures.
Click a signature you want to use:
Copyright © 1999-2020 Hush Communications Canada Inc.