RELEASE

FORMS

Below you will find release forms relating to your medical, dental, and insurance information.

 

Simply click or tap on the image to bring up an editable PDF. Make sure to download the documents before filling them in to ensure your changes are saved.

 

You can fill in the documents directly on your computer or phone - no more wasted paper! Once completed, please attach it to an email sent to pinoperio@gmail.com. Make sure to let us know which forms you're sending in the subject line. 

 

If you're feeling a bit more old-fashioned, you may (of course!) print out & fill in the document by hand. You can then hand it off to us the next time you're in the office.

Release to External Parties

Release to Pino Perio

New Mexico Dental Association
American Dental Association
American Academy of Periodontology
SPEAR Dental Education

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Pino Periodontics: Albuquerque's Specialists in Dental Implants, Gum Grafts, and Sedation Dentistry