Forms to Dismiss Patient & Release of Claims texdentlaw.GIF
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Forms for Patient Termination & Release of Claims:

   
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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,..."
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Patient Termination Letter
$10.00
Patient Termination Letter: Complies with Texas Administrative Code (TSBDE) Rule 108.5 Patient Abandonment (Click form for more information)
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© 2007 Boyd W. Shepherd, P.C.; Boyd W. Shepherd, D.D.S., J.D.