www.rhdp.com.au - Consent Form
  • Consent Form

  • Dear:

  • Re:

  • My patient has consulted this practice (Red Hill Dental Practice) for ongoing dental treatment. We understand that you hold records pertaining to previous treatment.

    To assist us in providing the most appropriate treatment, we ask for your help in supplying copies of dental records and relevant radiographs.

    To ensure compliance with the State and Federal Legislation, the patient's signed consent to this request is supplied below.

    We appreciate your assistance with this request. If you foresee any problems in providing the requested documents within the next week, please contact us as soon as possible.

    Please advise the patient of any fees which may be incurred under the Privacy Regulations.

    Thank you for your assistance.

    Kind regards,

    Dr. Chris Wooldridge
    Dr. Paul Gleeson
    Dr. Emma Barnsley
    Dr. Julia Gellatly
    Miss. Skye Greenhill

  • I give permission Dr Chris Wooldridge/Dr Paul Gleeson/ Dr Emma Barnsley/Miss Skye Greenhill only to seek copies of my dental records.

  • Clear
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  • 135 Shoreham Road | info@rhdp.com.au | rhdp.com.au | 5989 2144

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