Document/Patient records request

If you are requesting copies of patient records, 3300 forms, or other documentation, please submit your request with the required information outlined below. This allows our team to process your request accurately and efficiently.

Please note that all records requests may take 3–5 business days to complete, depending on the nature and volume of the request.

Contact Information:

Bold fields are required.

To ensure timely processing, please include the following details with your request:

Patient’s Full Name First and Last Patient’s Date of Birth Parent/Guardian's Full Name First and Last Phone Number Email Address
Specific details of the request (e.g., dental records, X-rays, 3300 form, date range, etc.)

 

Delivery preference

Email Fax In Office Pickup

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Submit Request

Incomplete requests may result in processing delays.

For your privacy and security, additional verification or authorization may be required prior to releasing records.

If you have any questions regarding your request, please contact our office directly. We appreciate your patience and will notify you once your records are ready.