Stowe Dental Associates

Patient Consent Form (age 18 & over)

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Patient’s Legal Name*
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I give the following individual(s) permission to speak on my behalf. They are allowed access to my billing information and/or medical records (for example: to schedule/cancel appointments, billing questions/payments, request for prescription refill, discuss dental care, etc.). I understand that I can add or remove anyone from this list at any time by filling out another consent form.

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Office Hours

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Monday – Thursday
8:00 AM – 4:30 PM

Stowe Dental Associates

Contact Us

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We believe that excellent care begins with open communication.

If you need more information, have any questions, or want to schedule an appointment, please contact us!

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32 Mountain Road
PO Box 1543
Stowe, VT 05672

DIRECTIONS

802.253.7932

info@stowedentalassociates.com

Hours: Mon – Thurs: 8:00 AM – 4:30 PM