Welcome to Clearwater Dental

Dental Record Release Form to Clearwater Dental

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

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

Release to Clearwater Dental

Please email records to info@clearwaterdental.com or mail them to 5000 West Clearwater Avenue, Kennewick, WA 99336

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 period charting.

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