Get Kitsap Kids Dentistry

Filling out the Kitsap Kids Dentistry authorization form online can streamline the process of transferring your child's dental records. This guide provides you with clear, detailed steps to ensure that you complete the form accurately and efficiently.

Follow the steps to complete the authorization form.

1. Click 'Get Form' button to obtain the form and open it in the online editor.
2. In the first section, enter the name of the parent or guardian requesting the release of dental records. Make sure to provide the full name clearly.
3. Next, fill in the name of the dental practice, which is Jessie M. Banks DDS, Kitsap Kid’s Dentistry, to confirm where the records are coming from.
4. Provide the recipient's information including the name of the dentist, their phone number, and physical address. Ensure all details are accurate to prevent any delays.
5. Input the parent or guardian’s name and address in the designated fields. This identifies who is authorizing the release.
6. List the names and dates of birth (DOB) of the child or children whose records are being requested. Ensure that each child's name is written clearly alongside their respective DOB.
7. At the bottom of the form, sign your name as the parent or guardian. This signature is essential for authorization.
8. Finally, date the form to indicate when the authorization was given. This date will be necessary for record-keeping purposes.
9. Once you've completed the form, save any changes you made. You can then download it, print a copy, or share it as needed.

Complete your child's dental records transfer online now.