Release of Records Form

The following form is Patient Authorization for Release of Records. Please only complete this form if you are requesting your dental health records be released TO another office or provider. In completing this form, you are requesting Thompson Family & Cosmetic Dentistry release your personal health information and records to the entities listed.

If you have any questions about your dental health records, please contact our office by calling 972-519-9787 during normal business hours. Thank you!