Request for Records

Request For Records
Laurier Dental Centre

500 Laurier Ave,

Milton, Ont., Canada

info@laurierdental.ca

905 878 9882 (O)

905 878 8415 (FAX)
Dear Dr. Doctor's Name ,

Patient's Name(s) has/have recently become a patient/patients in my practice.
RadiographsPanorexCharting of existing oral/dental conditionsNotes of your treatmentAny notes from referring specialistsMisc.
File Upload

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File Upload

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All of the above will be kept indefinitely should you require them in the future.

Thank you.
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Request For Records