Authorize Release or Request a Copy of Records
Step #1: Download an Authorization Form to Release Records
For your health records to be released to yourself or an outside party, an Authorization form (dental records) must be completed and returned. Records can only be sent by hard copy but radiographs may be sent by hard copy or emailed digitally.
Step #2: Please fax the completed Authorization forms to the appropriate clinic where you are making your request. Put “Attention Custodian of Records” on the cover of your fax. Fax numbers for each clinic can be found below.
- If you would like to receive electronic communications relating to your health records, please complete and return the Email Correspondence Consent form to receive electronic.
You may also authorize the release of your radiographs via email, please complete and return this Authorization form (email radiographs only) to one of the clinics below.
Please note that record duplication and/or releasing of records takes 5 to 7 business days and there is a nominal fee associated with the duplication of your records and any radiographs (includes CT scans).