Consent To Release Dental Records

Authorization

You Authorized Lyons Dental to release your dental records to the indicated office listed above.

Please allow 2 to 5 business days for records to be sent.
Thank You,
Lyons Dental
937-428-2288
Support@thelyonsdental.com

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Thank You!

We appreciate you taking the time to complete this form. We'll review the information submitted and be in touch with you if anything additional is required.

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