Get the free Dental Records Release Form - Paul E. Coggins, DDS, MPH
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Paul e. noggins DDS, MPH welcome paulcogginsdds.com Patient name Last First Initial Date of birth Previous Dentist or Practice Name: Address: City State Zip Code Phone Number: Please forward any of
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How to fill out dental records release form
How to fill out a dental records release form:
01
Begin by obtaining a dental records release form from your dentist's office. This form will typically ask for your personal information, such as your name, date of birth, and contact details.
02
Read the form carefully to understand the information it requests and any instructions provided. Make sure you are comfortable with releasing your dental records before proceeding.
03
Fill in your personal information accurately and legibly. It is important to provide the correct details to ensure that your records are properly released and delivered to the intended recipient.
04
Pay attention to any specific sections on the form that require additional information. This may include the specific dental provider or institution where your records need to be sent, along with their contact details.
05
Sign and date the form. By signing, you are giving consent for your dental records to be released as indicated on the form.
Who needs a dental records release form:
01
Patients switching dentists: If you are changing your dental provider and would like your new dentist to have access to your previous dental records, a dental records release form will be necessary. This allows for the transfer of your records from one dental office to another.
02
Individuals seeking specialized dental treatments: If you are consulting a specialist or undergoing a specific dental procedure that requires your past dental history, a dental records release form may be required. This ensures that the specialist has access to relevant information to provide effective and safe treatment.
03
Legal purposes: In some cases, dental records may be needed for legal proceedings or insurance claims. A dental records release form enables the authorized release of your dental records to the concerned parties involved in these legal matters.
It is important to note that the specific circumstances and requirements for a dental records release form may vary. Always consult with your dental provider or legal advisor for accurate information and guidance specific to your situation.
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