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Morgantown Dental Group - Release of Dental Information


hereby grant permission to

Any full mouth series, panoramic film, and BW’s to:

Morgantown Dental Group

142 High St

Morgantown, WV 26505

304-292-7307(phone) 304-292-1154(fax)

If films were taken digitally, they can be e-mailed to: [email protected]


(If a minor, parent or guardian must sign)