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2019/07/11 · Arshiya Sharafi DDS to release any Information including the diagnosis and the records of any treatment or examination rendered to my Insurance provider. I request

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Page 1: 2019/07/11 · Arshiya Sharafi DDS to release any Information including the diagnosis and the records of any treatment or examination rendered to my Insurance provider. I request

Page 2: 2019/07/11 · Arshiya Sharafi DDS to release any Information including the diagnosis and the records of any treatment or examination rendered to my Insurance provider. I request

Page 3: 2019/07/11 · Arshiya Sharafi DDS to release any Information including the diagnosis and the records of any treatment or examination rendered to my Insurance provider. I request

Page 4: 2019/07/11 · Arshiya Sharafi DDS to release any Information including the diagnosis and the records of any treatment or examination rendered to my Insurance provider. I request

Page 5: 2019/07/11 · Arshiya Sharafi DDS to release any Information including the diagnosis and the records of any treatment or examination rendered to my Insurance provider. I request

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