• Patient Record/xray release

  • I,* request my records/xrays to be transferred to the below dentist.

  • Murray Scholls Family Dental
    14845 SW Murray Scholls Dr, Ste 113 Beaverton, OR 97007
    Email:info@murrayschollsfamilydental.com

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: