Records Release Form

As a courtesy to our patients, we request records and XRays from your previous dentist. This ensures that we have the most recent X-Rays and do not have to take duplicate sets. We ask that you please fill out a records release form at least 24 hours prior to your dental appointment so that we can have time to request and receive your records.

You can fill out this form by coming into our office or by downloading the form, filling it out, and emailing it to our office at richardwalterdmd@gmail.com.