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Page 1: ProSites, Inc....'s dental needs. 2. Upon such diagnosis, I authorize doctor to perform ali recommended treatment mutually agreed upon by me and to employ such assistance as required
Page 2: ProSites, Inc....'s dental needs. 2. Upon such diagnosis, I authorize doctor to perform ali recommended treatment mutually agreed upon by me and to employ such assistance as required
Page 3: ProSites, Inc....'s dental needs. 2. Upon such diagnosis, I authorize doctor to perform ali recommended treatment mutually agreed upon by me and to employ such assistance as required
Page 4: ProSites, Inc....'s dental needs. 2. Upon such diagnosis, I authorize doctor to perform ali recommended treatment mutually agreed upon by me and to employ such assistance as required
Page 5: ProSites, Inc....'s dental needs. 2. Upon such diagnosis, I authorize doctor to perform ali recommended treatment mutually agreed upon by me and to employ such assistance as required
Page 6: ProSites, Inc....'s dental needs. 2. Upon such diagnosis, I authorize doctor to perform ali recommended treatment mutually agreed upon by me and to employ such assistance as required
Page 7: ProSites, Inc....'s dental needs. 2. Upon such diagnosis, I authorize doctor to perform ali recommended treatment mutually agreed upon by me and to employ such assistance as required

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