Release Form"*" indicates required fields SINGER DENTAL DR. MARSHALL Z. SINGER 362 KINGSTON RD. UNIT 1 AJAX, ONTARIO L1T 3A4 (905)903-3848 reception@singerdental.comDate*INFORMATION RELEASE:To(Previous Dental Office)PhoneEmail I hereby give permission to release my dental treatment records, charting, and images including radiographs to Singer Dental.(Patient/Parents/Guardian Signature)*Consent* By submitting this form, I agree to receive marketing messages, including special offers, updates, and news, and understand I can change my preferences at any time. See our Privacy Policy.*
