Professional Dental Records Release Form Template. Request for release of records date: Check here to send this basic information;
I authorize the release of my confidential protected dental information, as described in my directions above. Request for release of records date: This includes text fields for names and contact.
Download the release of records consent form. Browse 9 dental records release form templates collected for any of your needs. _____ i hereby authorize the release of my dental records or copies of such and request that they are transferred to:
If you want additional records transferred to dental provider, please check “clinical records” or “specific records” toward the top of this form). You may also request your records and other documents by phone or order an electronic copy of your detailed medical records online. Our dental records release form allows you to add various fields to gather specific information from your clients.
I authorize the release of my confidential protected dental information, as described in my directions above. This includes text fields for names and contact. Check here to send this basic information;
Office name _____ number_____ email _____ to send records to Request for release of records date: Quickly collect important information from your patients with formstack’s dental records release form.
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