INFORMED CONSENT: I hereby give Dr. David Morrow and/or members of his staff permission to collect all relevant personal information and to release this information concerning my dental and/or orthodontic health to the family physician, dentist or any other dental specialist as is deemed necessary. Such information includes x-rays and other diagnostic records which pertains to the initial condition, diagnosis, proposed treatment or treatment in progress. Financial information will be used specifically for billing purposes. We will provide the highest level of confidentiality with respect to the collection and disclosure of all of your personal information that is provided to us. Correspondence with yourself or any of the healthcare providers specifically mentioned above, may be via email or regular mail as required. By signing below, I accept the terms indicated above and I have been given the opportunity to ask all questions related to this form. I confirm that to the best of my knowledge, I have completed this form accurately, and all information recorded is correct.
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