Dental Records
Dental Records
Patients are entitled to copies of their current dental records, as per the Patient Bill of Rights. To protect the confidentiality of your dental records and before we can release your dental records, you must provide written authorization.
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).
Email Correspondence Consent Form
Authorization Form to Release Records
Authorization for the Release of Radiographs
Clinic Directory of Fax Numbers
| Clinic Name | Type of Provider | Fax Number |
|---|---|---|
| General Student Clinic - Westwood | Student | (310) 825-7620 |
| General Student Clinic - Venice | Student | (310) 392-8513 |
| Advanced Education in General Dentistry | Resident | (310) 825-7620 |
| Center for Esthetic Dentistry | Resident | (310) 825-7620 |
| Pediatric Dentistry Clinic (Westwood Pediatrics) | StudentResident | (310) 825-7620 |
| Endodontics - Weichman Endodontic Clinic | Resident | (310) 825-7620 |
| Faculty Group Dental Practice | Faculty | (310) 208-0786 |
| Graduate Orofacial Pain | Resident | (310) 825-7620 |
| Graduate Prosthodontics | Resident Faculty | (310) 206-4201 |
| Special Patient Care (Hospital Dentistry) | Resident Faculty | (310) 206-4201 |
| Maxillofacial Prosthetics | Resident Faculty | (310) 206-4201 |
| Oral and Maxillofacial Surgery | Student Resident Faculty | (310) 825-7620 |
| Oral Medicine Faculty Practice | Faculty | (310) 825-2124 |
| Oral Radiology | Faculty | (310) 825-7620 |
| Orofacial Pain Faculty Practice | Faculty | (310) 825-2124 |
| Orthodontics - Thomas R. Bales Orthodontics Clinic | Resident | (310) 825-7620 |
| Postgraduate Periodontics and Implant Surgery | Resident | (310) 825-7620 |
| Wilson-Jennings-Bloomfield UCLA Venice Dental Center | Student Resident Faculty | (310) 392-8513 |
Contact Us
For questions regarding the process to request a copy or authorize the release of your health records:
Westwood:
Direct: (310) 825-3195 | Fax: (310) 825-7620
sodpatientrecords@mednet.ucla.edu
Venice Dental Center:
Direct: (310) 392-4103 | Fax: (310) 392-8513
vdc@dentistry.ucla.edu
Faculty Group Dental Practice:
If you need to request a copy of your records, please call (310) 794-5750, email us at FGDP@dentistry.ucla.edu, or fax us at (310) 208-0786.