Request Dental Records

You can request that your child’s dental records and X-rays be sent to you or to a dentist/dental office if more dental care is needed. To protect your child’s privacy, we can only send dental records to the custodial parent or legal guardian or to a dentist/dental office for purposes of continuing dental care.


To the following dentist or dental office:


To the parent or guardian:

By submitting this document, you are acknowledging the risk that by sending this form the information provided may be intercepted and read by a third party. If you do not wish to accept this risk, please call 855.469.7473.

For all other requests, please call 855.469.7473.