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Allyn G. Perkins, DMD, LLC 1909 Ritner Highway, Suite 2 Carlisle, PA 17013 7172491646 Office 7172490951 Fax Email: perkins1909@gmail.com Website: www.carlisledentist.comDENTAL RECORDS TRANSFER REQUEST
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How to fill out dental transfer request
How to fill out dental transfer request
01
To fill out a dental transfer request, follow these steps:
02
Obtain a dental transfer request form from your dentist or the dental clinic.
03
Fill out your personal information, including your name, address, phone number, and date of birth.
04
Provide details about your current dentist, including their name, address, and phone number.
05
Specify the reason for requesting a dental transfer.
06
If applicable, include any relevant dental treatment information, such as the date of your last visit or any ongoing dental issues.
07
Sign and date the dental transfer request form.
08
Submit the completed form to your new dentist or dental clinic either in person or through the provided contact details.
09
Follow up with the new dentist or dental clinic to ensure that the transfer request has been received and processed.
Who needs dental transfer request?
01
Anyone who wishes to change their current dentist or dental clinic may need a dental transfer request. This request is commonly used when individuals move to a new location or are unsatisfied with their current dental service provider. It allows the individual to request the transfer of their dental records and ongoing treatment to a new dentist or dental clinic.
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What is dental transfer request?
A dental transfer request is a formal document used to transfer a patient's dental records and treatment history from one dental provider to another.
Who is required to file dental transfer request?
The dental transfer request is typically filed by the patient or their legal guardian when they choose to switch dental providers.
How to fill out dental transfer request?
To fill out a dental transfer request, the patient must provide their personal information, the details of the previous dental provider, and the new provider's information along with their consent for the transfer.
What is the purpose of dental transfer request?
The purpose of a dental transfer request is to ensure that new dental providers have access to a patient's complete dental history for accurate diagnosis and treatment.
What information must be reported on dental transfer request?
The dental transfer request must include the patient's full name, contact information, previous provider's details, new provider's information, and signature authorizing the release of records.
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