MEDICAL RECORDS RELEASE FORM

I

, DOB: 

authorize to release my medical records and or x-rays to Arizona Periodontics.


Address: 801 N. Wilmot Road, Ste B2. Tucson, AZ 85711

Email address: azperio@protonmail.com

Phone Number: (520)881-2940

Fax Number: (520)881-0209

Responsible Party/ Guardian  

ANDREW E. DEEB, D.M.D., M.S., P.C.

JANINA GOLOB DEEB, D.D.S., M.S. 

PERIODONTICS AND IMPLANTS

4008 E. PIMA, TUCSON, ARIZONA 85712 (520) 881-2940

Contact Information

Address: 801 N Wilmot Rd Suite B2 Tucson, AZ 85711
Hours of Operation: 
Mon - Thu
-
Friday
Appointment Only
Sat - Sun
Closed
Visa Payment Accepted
MasterCard Payment Accepted
Discover Payment Accepted
American Express Payment Accepted
Cash Payment Accepted
Debit Payment Accepted

Location

Contact Information

Address: 801 N Wilmot Rd Suite B2 Tucson, AZ 85711
Hours of Operation: 
Mon-Thu 8:00 AM - 5:00 PM 
Friday by Appointment Only 
Sat-Sun Closed 
Visa Payment Accepted
MasterCard Payment Accepted
Discover Payment Accepted
American Express Payment Accepted
Cash Payment Accepted
Debit Payment Accepted

Location