Get the free Dental Records Release Form

This form authorizes the release of dental records from a previous dentist or practice to Scott Taylor DDS. Patients need to provide their personal information and consent to the release of their records, including any x-rays and photographs.

How to fill out dental records release form

How to fill out dental records release form

1. Obtain the dental records release form from your dental office or their website.
2. Fill in your personal information, including your name, address, phone number, and date of birth.
3. Provide the name and contact information of the dental office or professional to whom you are releasing the records.
4. Specify the purpose of the records request, such as for a new dentist or insurance purposes.
5. Sign and date the form to authorize the release of your dental records.
6. Submit the completed form to the dental office holding your records, either in person or via email/fax.

Who needs dental records release form?

1. Patients transferring to a new dental provider.
2. Individuals applying for dental insurance.
3. Dental providers requesting records for continuity of care.
4. Legal representatives involved in personal injury or malpractice cases.

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What is dental records release form?

A dental records release form is a document that allows a patient to authorize the transfer of their dental records from one dental practice to another, or to a third party.

Who is required to file dental records release form?

Typically, the patient or their legal guardian is required to file a dental records release form when they wish to transfer their dental records.

How to fill out dental records release form?

To fill out a dental records release form, the patient must provide their personal information, the name of the dental practice transferring the records, the name of the receiving practice, and may also need to specify the information being shared and the purpose of the release.

What is the purpose of dental records release form?

The purpose of a dental records release form is to ensure that patient consent is obtained for sharing their confidential dental information, thereby protecting patient privacy and complying with legal requirements.

What information must be reported on dental records release form?

The form must typically include the patient's name, contact information, social security number, the name and address of the dental practices involved, specific records being released, and the signature of the patient or their representative.