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REQUEST FOR RELEASE OF DENTAL/MEDICAL RECORDS Today's Date: Previous Dental Office: Fax#: Email: I hereby authorize the release of any dental/medical records your office has for named patients below:
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01
Collect all your dental records from your previous dental office.
02
Fill out a release of records form to authorize the transfer of your dental records to the new dental office.
03
If you have any outstanding balances or insurance claims with your previous dental office, make sure to settle them before leaving.
04
Schedule an appointment with your new dental office and inform them about your intention to transfer your records.
05
Provide the necessary information and documents to the new dental office, such as your contact details, insurance information, and any relevant medical history.
06
Follow up with the new dental office to ensure that they have received your records and successfully transferred them.
07
Once your records have been transferred, you can proceed with any necessary dental treatments or appointments at the new dental office.

Who needs previous dental office?

01
Anyone who has previously received dental treatments or services from a dental office and wishes to switch to a new dental office may need their previous dental office records.
02
These records are important for maintaining continuity of care and providing the new dental office with relevant information about the patient's dental history, previous treatments, and any ongoing dental issues.
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Previous dental office refers to the dentist or dental clinic that a patient has visited before their current dental appointment.
The dental office staff or the patient themselves may be required to provide information about the previous dental office.
To fill out previous dental office, provide the name of the dental office, address, contact information, and dates of the previous visits.
The purpose of reporting previous dental office is to have a complete record of the patient's dental history and treatments.
Information such as the name of the dental office, address, contact information, and dates of previous visits must be reported.
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