Federal law prohibits transfer of confidential medical information without a release signed by the patient or legal guardian. You can download a release form to have your dental records transferred to or from another dentist. Please print the form out and fill in the blanks. Then bring, mail or fax it to the office from which you want to the records to be transferred.
Download a Referral Form (for dental office use).
We encourage you to contact us whenever you have an interest or concern about dental implants, gum disease, or crown lengthening in Eureka.
Contact us with the form below: