Dental Records Transfer Request Form

Transferring dental records shouldn't be complicated. Whether you're moving to a new area, switching providers, or seeking a specialist consultation, our Dental Records Transfer Request Form makes it simple for patients to request their complete dental history with proper consent and clear specifications.

This template is designed for dental practices, orthodontists, oral surgeons, and dental specialists who need a HIPAA-compliant way to process patient record requests. The form captures all necessary patient consent, identifies exactly which records are needed (including x-rays, treatment notes, and billing history), and collects complete information about the receiving provider.

For dental office managers and administrative staff, this form eliminates the back-and-forth phone calls and missing information that typically delay records transfers. Patients can specify their treatment history date range, indicate whether they need x-rays included, and provide their new dentist's information—all in one submission.

Healthcare providers will appreciate how this template ensures compliance with patient privacy regulations while streamlining what can otherwise be a time-consuming administrative task. The built-in consent language protects your practice, and the structured data makes it easy to fulfill requests accurately.

Need to automate what happens after submission? Connect this form to Stepper to automatically notify your records department, create tasks in your practice management system, log requests in your CRM, and send confirmation emails to both the patient and receiving provider. You can even set up approval workflows for sensitive records or track processing times to improve your service standards.

Built with Paperform's flexible design system, you can match this form to your practice's branding and embed it directly on your website, making it easy for patients to initiate transfers without having to visit your office or mail in forms.