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Forms to 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)