Release Form SINGER DENTAL DR. MARSHALL Z. SINGER 362 KINGSTON RD. UNIT 1 AJAX, ONTARIO L1T 3A4 (905) 903-3848 reception@singerdental.comDate(Required) 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)(Required)CAPTCHA