Records Release Form

Thank you for choosing Chapman Mills Dental for the care of your patients. 

Please complete the form below to submit your patient's medical records to our office.

We at Chapman Mills Dental and the above patient(s) would like to thank you for the care you have shown them in the past. In order to provide them with the same continuing care, we would appreciate it if you would please forward their most recent radiographs and records that you may have on file. All information received will be held in the strictest confidence. Diagnostically acceptable duplicate films and photocopies of written records would be appreciated.
Kindly provide the following information:

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Looking for a dentist in Ottawa? We're accepting new patients at our dental clinic! Contact us to get started today. 

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