Dental Health History Forms
Dental Health History Forms | dental health history form

Ten Moments That Basically Sum Up Your Dental Health History Form Experience | Dental Health History Form

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To access a archetype of your dental record, you should abide a active and dated Authorization to Disclose Dental Annal Anatomy (links to forms are amid below). Dental annal can accommodate medical history, pathology, radiology, lab reports, and added acute advice such as abiogenetic testing, ually transmitted diseases, and HIV analysis results, etc. and are added adequate by federal laws. Therefore, if you would like such advice to be released, you charge accurately announce so on our allotment anatomy by initialing the corresponding class of information.

Authorization to Disclose Dental Annal Anatomy (English)

Authorization to Disclose Dental Annal Anatomy (Español)

Contact Advice for Division of Dental Records

Phone: 617-358-3403Fax: 617-638-4764

Monday–Friday, 8 a.m. to 5 p.m.

Boston University Henry M. Goldman School of Dental MedicineDivision of Dental Records100 East Newton Street, G-02Boston, MA 02118

You should accept your annal in about 1-2 weeks. We will do our best to acknowledge to your requests aural a appropriate manner. If your appeal is urgent, the Division of Dental Annal can be contacted at 617-638-4710 or you may appointment us during approved business hours to accomplish appropriate arrangements.  Your dental advice can additionally be beatific electronically instead of accepting us mail it to you. Regardless of the advantage you choose, amuse be abiding to accelerate or accompany accurate photo identification with you for absolution of the records.

If the accommodating is a accessory or is not competent, affidavit of acknowledged representation is needed. For asleep patients, the appeal for dental annal charge be submitted with affidavit proving you are the patient’s aing of kin (death affidavit with name of adviser or probate certificate allotment administrator). Addition advice may be appropriate for these requests.

If you are calling afterwards hours, amuse leave a bulletin and your alarm will be alternate as anon as possible.

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