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Download - Dentist in Mansfield OH | Andrew C Basinger DDS · 375 Lexington Avenue Mansfield, Ohio 44907 Telephone: (419) 756-4667 PRIVACY CONSENT For the USE and Disclosure of Protected Health

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Page 1: Dentist in Mansfield OH | Andrew C Basinger DDS · 375 Lexington Avenue Mansfield, Ohio 44907 Telephone: (419) 756-4667 PRIVACY CONSENT For the USE and Disclosure of Protected Health

Page 2: Dentist in Mansfield OH | Andrew C Basinger DDS · 375 Lexington Avenue Mansfield, Ohio 44907 Telephone: (419) 756-4667 PRIVACY CONSENT For the USE and Disclosure of Protected Health

Page 3: Dentist in Mansfield OH | Andrew C Basinger DDS · 375 Lexington Avenue Mansfield, Ohio 44907 Telephone: (419) 756-4667 PRIVACY CONSENT For the USE and Disclosure of Protected Health

Page 4: Dentist in Mansfield OH | Andrew C Basinger DDS · 375 Lexington Avenue Mansfield, Ohio 44907 Telephone: (419) 756-4667 PRIVACY CONSENT For the USE and Disclosure of Protected Health

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