Get Dental Records Transfer Form

Completing the Dental Records Transfer Form online is an essential step in ensuring your dental records are transferred seamlessly. This guide will provide a clear and supportive approach to filling out the form accurately and efficiently.

Follow the steps to transfer your dental records online.

1. Click ‘Get Form’ button to access the Dental Records Transfer Form and open it in your preferred editor.
2. Indicate your request to transfer your dental records by checking the appropriate box next to the statement that reads ‘Please transfer my dental records to Seacoast Dentistry, PLLC.’
3. In the next section, provide the contact details for Seacoast Dentistry by entering their email address (contact@seacoastdentistry.com), fax number (207-282-3793), and phone number (207-282-6185).
4. Next, if you have requested a copy of your dental records to be sent to another dentist, ensure you check the corresponding box to indicate this choice.
5. Fill in the name of the dentist you wish to receive your records by writing it in the designated field labeled ‘Dentist Name.’
6. Complete the section that requires the dentist's address by providing the full address in the space indicated.
7. In the area labeled ‘Printed Name,’ write your name clearly, as it appears in your official documents.
8. Date the form by filling in the current date in the space provided.
9. Finally, sign the form in the space designated for your signature to authorize the transfer of records.
10. After completing the form, you may save your changes, download a copy, print it out, or share it as needed.

Take the next step in managing your dental records by completing the Dental Records Transfer Form online.