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Singing Hills Animal Hospital 1951 Willow Glen Drive El Cajon, Ca. 92019 DENTAL RELEASE FORM Owner's Name: Pet's Name: Date: Breed: Address: Sex: Age: Phone: Color: I, the undersigned, do hereby certify

How to fill out dental release form

How to fill out a dental release form:

1. Start by providing your personal information, including your full name, date of birth, address, phone number, and email.
2. Indicate the name of your dental provider and their contact information, such as the dental clinic's name, address, phone number, and email.
3. Specify the purpose of the release form, whether it's for a routine dental check-up, a specific treatment, or for the transfer of your dental records to another dentist.
4. Read the form carefully and make sure you understand its contents. If you have any questions or concerns, don't hesitate to ask the dental staff for clarification.
5. Consent to the release of your dental information by signing and dating the form. This indicates that you authorize the dental provider to share your dental records, x-rays, treatment history, and any other relevant information with other professionals involved in your dental care.
6. If applicable, indicate any specific limitations or restrictions on the release of your dental information. For example, you might want to specify that only certain dental records or information can be shared or that the release is only valid for a specific period.
7. Review the contact information provided on the form to ensure its accuracy. This will allow the dental provider to easily reach out to you or any other professionals involved in your care, if needed.

Who needs a dental release form:

1. Patients who are transferring their dental care to a new provider may require a dental release form. This allows the new dentist to access the patient's previous dental records and provide continuity of care.
2. Individuals seeking a second opinion from another dentist may need to sign a dental release form to authorize the release of their dental records for review by the new provider.
3. Patients undergoing special dental treatments, such as surgeries or extensive procedures, may be required to fill out a dental release form to ensure that their dental information is shared with any specialists or healthcare professionals involved in the treatment.

Overall, dental release forms are commonly used to facilitate the exchange of dental information between dental providers, ensuring that patients receive appropriate and continuous care.

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What is dental release form?

A dental release form is a document that gives a dentist permission to release a patient's dental records.

Who is required to file dental release form?

Any patient who wants their dental records to be released to another party is required to file a dental release form.

How to fill out dental release form?

To fill out a dental release form, the patient must provide their personal information, specify who the records should be released to, and sign the form.

What is the purpose of dental release form?

The purpose of a dental release form is to authorize the release of a patient's dental records to a specified individual or organization.

What information must be reported on dental release form?

The dental release form must include the patient's name, date of birth, contact information, the recipient of the records, and the purpose for the release of the records.