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Release of Records
A release of records allows our office to provide a copy of your dental records, such as X-rays, treatment notes, and other relevant information, to you or to another dental office with your written permission.
Please complete the Release of Records Request form below and email the completed form back to our office at youngsmilesphilly@gmail.com. A $20 processing fee applies to each request. Once the completed form and payment are received, we will send your records by email according to the information provided on the form.
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