NOTE: Please do not complete this paperwork until we have you scheduled for an appointment. If you are not currently scheduled, please call the office at 207-239-6099 or email firstname.lastname@example.org to set something up.
Or you can download, print, and fill them out:
If you are looking to release records from our office to another dental office (i.e. you’ve moved or are transferring care to another office), you can fill out the electronic version of our HIPAA Release here.
Or print and fill out the form below. This can be emailed to email@example.com or faxed to 207-221-8132.