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DENTAL RECORDS REQUESTPatient Name: I authorize Dr. Phone # Fax # To release my dental record to:Gerald K. Wolff, DMD, ABED 4400 California Ave. S.W. Seattle, WA 98116 Phone 206 9356286 FAX 206 9351326
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How to fill out to release my dental
How to fill out to release my dental
01
To fill out a dental release form, follow these steps:
02
Obtain a dental release form from your dentist or dental office.
03
Read the form carefully and make sure you understand all the information and requirements.
04
Provide your personal details such as name, date of birth, address, and contact information.
05
Specify the reason for the dental release, whether it is for transferring dental records or authorizing the release of information.
06
Sign and date the form at the designated fields.
07
If required, provide any additional information or documentation requested by the dental office.
08
Make a copy of the completed form for your records.
09
Submit the form to your dental office either in person, through mail, or by using any preferred method of communication.
10
Follow up with the dental office to ensure that the form has been received and processed.
Who needs to release my dental?
01
There are several situations in which someone may need to release their dental records:
02
Patients who are switching dentists or moving to a new location may need to release their dental records to their new dental provider.
03
Individuals involved in legal matters or insurance claims may be required to release their dental records to support their case.
04
Medical researchers or professionals conducting studies or research related to dental health may need access to dental records.
05
In some cases, employers or educational institutions may request dental records for verification or health-related purposes.
06
Overall, anyone who wants to transfer their dental records or authorize the release of their dental information may need to fill out a dental release form.
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