Joseph K. Vargo, D.M.D., M.S.
I grant Dr. Vargo permission to use and display patient’s photos for educational purposes.
If the patient is a minor, it is necessary that a signed permission is obtainedfrom a parent or guardian before any and / or all necessary dental service can be started and accomplished by the doctor.
Authorization is hereby granted as such. Furthermore, I will be responsible for any bill incurred on this childfor dental treatment.
Signature (Patient, Parent or Guardian)
Thank you for your cooperation. The above information is important in the diagnosis and treatment of the patient and will be kept in strict conﬁdence.