Transcription of ARROWHEAD DERMATOLOGY
1 ARROWHEAD DERMATOLOGY . 7767 W. Deer Valley Rd. Ste #140* Peoria, AZ 85382* 623-487-3003*fax 623-487-0952. RECORDS RELEASE. PATIENT_____. PHONE # I authorize ARROWHEAD DERMATOLOGY to release my medical records to_____. Phone #_____ Fax#_____. Address_____. _____. _____. Signature Date _____. Witness Date RECORDS RELEASE. PATIENT: _____DOB_____. PHONE #: _____. I authorize Phone #: _____ Fax #:_____. To release my medical records to: ARROWHEAD DERMATOLOGY . 7767 W. Deer Valley Rd Ste. 140. Peoria, AZ 85382. Phone: 623-487-3003*Fax: 623-487-0952. _____. Signature Date _____. Witness Dat
