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I authorize Dr. Antalis permission to give copies of any dental/medical records via mail or e-mail to my other health care providers including medical doctors, chiropractor, physiotherapists, E.N.T. specialists, neurologists, etc. or lawyers acting on my behalf.

I release you from all legal responsibility or liability that may arise from this authorization. *

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Here at OHIOSmiles, you are a first priority. Here, have a look, meet the team before you come see us. Our staff is friendly and professional. Learn more here.
OHIOSmiles, 1500 Deerpath Drive, Cambridge, OH 43725; (740) 781-0540; ohiosmiles.com; 7/4/2022; Related Phrases: dentist Cambridge OH;