Dental Record Release Forms To Clearwater Dental
If you would like to authorize Clearwater Dental to receive your dental records from another practice, you have the option submit the request on our website below, or print out the PDF form to fill out. You may bring them into the office or mail them to our address at: Clearwater Dental, 5000 W Clearwater Ave, Kennewick, WA 99336.
Authorization to release my information
I authorize the previous dentist or healthcare provider below to release the following dental information to Clearwater Dental. This includes all health care information, current full mouth, panoramic, bitewing x-rays and perio charting.