Authorization for Release Form
Please fill out the below forms to release your Dental or Health information to a specific party.
Authorization for Release Form – St Michael
Authorization for Release Form – St Michael
622 Roosevelt Rd. Suite 180
St. Cloud, MN 56301
St. Cloud, MN 56301
750 Central Ave. E Suite 202
St. Michael, MN 55376
St. Michael, MN 55376
9381 Cedar St.
Monticello, MN 55362
Monticello, MN 55362
1100 19th Ave. SW Suite 202
Willmar, MN 56201
Willmar, MN 56201
622 Roosevelt Rd. Suite 180
St. Cloud, MN 56301
St. Cloud, MN 56301
750 Central Ave. E Suite 202
St. Michael, MN 55376
St. Michael, MN 55376
9381 Cedar St.
Monticello, MN 55362
Monticello, MN 55362
1100 19th Ave. SW Suite 202
Willmar, MN 56201
Willmar, MN 56201
St. Cloud Office
St. Michael Office
Monticello Office
Willmar Office
