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Dismiss Patient, Release of Claims
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Forms for Patient Termination & Release of Claims:
Patient Release of Claims
$10.00
Patient Release of All Claims:
Release form for settlement of dispute between patient and provider, stating that
"payment constitutes a final and full settlement of any claim I might have against the dentist in this particular case,..."
Patient Termination Letter
$10.00
Patient Termination Letter:
Complies with Texas Administrative Code (TSBDE) Rule 108.5 Patient Abandonment (Click form for more information)
