div class=trans-pagebutton class=gotoPage data-page=1Page 1button div class=trans-imageimg data-url=documentc1-ffeae-mme-name-h-over-1b-name-here-main-street-dental-consent-for-use-and-disclosurehtmlpage=1 data-page=1 class=trans-thumb lazyload alt=Page 1: c1-previewprositescomc1-previewprositescom86831wydocsimg009pdf · ffea$e Mme name h over 1B name here Main Street Dental CONSENT FOR USE AND DISCLOSURE OF HEALTH INFORMATION loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAQAAAC1HAwCAAAAC0lEQVR42mM8Uw8AAh0BTZud3BwAAAAASUVORK5CYII= data-src=https:reader034fdocumentsusreader034viewer20220520006011c402c62d7b61135a5efbhtml5thumbnails1jpg width=140 height=200 divdiv