D.D.S., M.S.
D.D.S.
Endodontics
D.M.D.
D.D.S., Ph.D.
Periodontics
D.D.S., F.A.G.D.
B.D.S., M.D.S.
Oral Radiology
D.D.S., M.P.H.
General Medicine
B.D.S., D.M.D.
D.O., F.A.A.O.
D.O.
Pharm.D.
PT, MS
PT, DPT, OCS
PT, D.P.T., M.H.S.
PT, Ph.D.
PT, DPT, MS
O.D., FAAO
Low Vision, ERG
Cornea/Contact Lens, Dry Eye
O.D., FAAO, FSLS
Contact Lenses
O.D.
Ocular Disease
O.D., Ed.M, FAAO
Cornea & Specialty Contacts
VT Therapy & Rehab, Pediatrics
M.S., CCC-SLP
Speech Pathology
PH.D., CCC-SLP
Ph.D., CCC-SLP
M.A., CCC-SLP
This authorization will expire 1 year from 09/29/2023.
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Behavioral Health Notes / Record I authorize the disclosure of any behavioral health notes or information in my medical record.
With my digital signature below, I consent to the release of the above listed information / documents.
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