Dr. Greg Broyde BSc, DDS
Dr. Navdeep Dhaliwal BSc, DDS
526 Riverfront Ave SE
Calgary AB T2G 1E4
Ph: 403 263 9014

X-rays Release

I give permission to release my dental x-rays and information to East Village Dental.

As well as family members:

Previous Dental office:

City:

Today's Date

Sign above