Orthodontic Release Form - I, _____________________________ hereby request to discontinue my/my child’s orthodontic treatment, and remove all orthodontic appliances, even. Orthodontic treatment requires the full cooperation of the. Patient uncooperative or noncompliant and discontinuation of treatment is in his/her best interest. I further acknowledge that said doctor has advised me against removal of said appliances at this time,.
Patient uncooperative or noncompliant and discontinuation of treatment is in his/her best interest. Orthodontic treatment requires the full cooperation of the. I further acknowledge that said doctor has advised me against removal of said appliances at this time,. I, _____________________________ hereby request to discontinue my/my child’s orthodontic treatment, and remove all orthodontic appliances, even.
Patient uncooperative or noncompliant and discontinuation of treatment is in his/her best interest. Orthodontic treatment requires the full cooperation of the. I further acknowledge that said doctor has advised me against removal of said appliances at this time,. I, _____________________________ hereby request to discontinue my/my child’s orthodontic treatment, and remove all orthodontic appliances, even.
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I further acknowledge that said doctor has advised me against removal of said appliances at this time,. Patient uncooperative or noncompliant and discontinuation of treatment is in his/her best interest. I, _____________________________ hereby request to discontinue my/my child’s orthodontic treatment, and remove all orthodontic appliances, even. Orthodontic treatment requires the full cooperation of the.
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I further acknowledge that said doctor has advised me against removal of said appliances at this time,. Orthodontic treatment requires the full cooperation of the. I, _____________________________ hereby request to discontinue my/my child’s orthodontic treatment, and remove all orthodontic appliances, even. Patient uncooperative or noncompliant and discontinuation of treatment is in his/her best interest.
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I, _____________________________ hereby request to discontinue my/my child’s orthodontic treatment, and remove all orthodontic appliances, even. Patient uncooperative or noncompliant and discontinuation of treatment is in his/her best interest. I further acknowledge that said doctor has advised me against removal of said appliances at this time,. Orthodontic treatment requires the full cooperation of the.
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I further acknowledge that said doctor has advised me against removal of said appliances at this time,. Patient uncooperative or noncompliant and discontinuation of treatment is in his/her best interest. Orthodontic treatment requires the full cooperation of the. I, _____________________________ hereby request to discontinue my/my child’s orthodontic treatment, and remove all orthodontic appliances, even.
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Orthodontic treatment requires the full cooperation of the. Patient uncooperative or noncompliant and discontinuation of treatment is in his/her best interest. I further acknowledge that said doctor has advised me against removal of said appliances at this time,. I, _____________________________ hereby request to discontinue my/my child’s orthodontic treatment, and remove all orthodontic appliances, even.
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I, _____________________________ hereby request to discontinue my/my child’s orthodontic treatment, and remove all orthodontic appliances, even. Orthodontic treatment requires the full cooperation of the. I further acknowledge that said doctor has advised me against removal of said appliances at this time,. Patient uncooperative or noncompliant and discontinuation of treatment is in his/her best interest.
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Patient uncooperative or noncompliant and discontinuation of treatment is in his/her best interest. I, _____________________________ hereby request to discontinue my/my child’s orthodontic treatment, and remove all orthodontic appliances, even. Orthodontic treatment requires the full cooperation of the. I further acknowledge that said doctor has advised me against removal of said appliances at this time,.
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I further acknowledge that said doctor has advised me against removal of said appliances at this time,. Patient uncooperative or noncompliant and discontinuation of treatment is in his/her best interest. Orthodontic treatment requires the full cooperation of the. I, _____________________________ hereby request to discontinue my/my child’s orthodontic treatment, and remove all orthodontic appliances, even.
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I, _____________________________ hereby request to discontinue my/my child’s orthodontic treatment, and remove all orthodontic appliances, even. I further acknowledge that said doctor has advised me against removal of said appliances at this time,. Orthodontic treatment requires the full cooperation of the. Patient uncooperative or noncompliant and discontinuation of treatment is in his/her best interest.
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Orthodontic treatment requires the full cooperation of the. I further acknowledge that said doctor has advised me against removal of said appliances at this time,. I, _____________________________ hereby request to discontinue my/my child’s orthodontic treatment, and remove all orthodontic appliances, even. Patient uncooperative or noncompliant and discontinuation of treatment is in his/her best interest.
I Further Acknowledge That Said Doctor Has Advised Me Against Removal Of Said Appliances At This Time,.
Patient uncooperative or noncompliant and discontinuation of treatment is in his/her best interest. Orthodontic treatment requires the full cooperation of the. I, _____________________________ hereby request to discontinue my/my child’s orthodontic treatment, and remove all orthodontic appliances, even.