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Dental Record Release Form from Clearwater Dental

Submit your forms direclty online to save time at the office.

If you would like to authorize us to release your dental records from Clearwater Dental to another practice, you may either fill out and submit the form below, or print out the PDF form to fill out and bring to our office (or mail to: Clearwater Dental, 5000 W Clearwater Ave, Kennewick, WA 99336).

Release from Clearwater Dental

I authorize Clearwater Dental to release the following dental information to the dentist or healthcare provider below. This includes all health care information, current full mouth, pano, bitewing xrays, and periodontal charting.

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