d11upr8lrcn9x7.cloudfront.net€¦ · company to pay directly to the dentist or dental group...

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Page 1: d11upr8lrcn9x7.cloudfront.net€¦ · company to pay directly to the dentist or dental group insurance benefits otheNise payable to me. I authorize the doctor to release all information
Page 2: d11upr8lrcn9x7.cloudfront.net€¦ · company to pay directly to the dentist or dental group insurance benefits otheNise payable to me. I authorize the doctor to release all information