Request For Dental Records Letter Sample

Are you in need of a Request For Dental Records Letter Sample? Look no further! Below, you will find examples of Request For Dental Records Letter Sample that you can use as a template. Feel free to modify them as needed to suit your specific situation.

Explaining the Need for Request For Dental Records Letter Sample

When you are changing dental providers, submitting an insurance claim, or seeking legal action related to dental treatment, you may need to request your dental records. A Request For Dental Records Letter is a formal document that allows you to obtain copies of your dental records from your current or previous dental provider. This letter serves as a written request for the release of your dental records and ensures that you have access to important information regarding your oral health history.

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Example of Request For Dental Records Letter Sample:

Dear [Recipient’s Name],

I am writing to request copies of my dental records from your office. I was a patient at your practice from [Month, Year] to [Month, Year], and I would like to obtain a complete set of my dental records for my personal records.

My name is [Your Name], and my date of birth is [Date of Birth]. Please find enclosed a signed authorization form allowing the release of my dental records to me. I would appreciate it if you could provide me with the requested records within [Specify Timeframe, e.g. 30 days] days of receiving this letter.

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If there are any fees associated with obtaining copies of my dental records, please let me know in advance. I am willing to cover any reasonable costs for processing and copying the records.

Thank you for your prompt attention to this matter. If you have any questions or require further information, please do not hesitate to contact me at [Your Phone Number] or [Your Email Address].

Sincerely,

[Your Name]

Signature: ________________________