New PatientsBook an Appointment and Transfer your RecordsWe love meeting New Patients and Families! The above named patient(s) have recently become patient(s) at our office. I understand that you may have records/radiographs, would you kindly forward the patient's Odontogram, note history, specialist's reports, pre-determinations for any treatment in progress and copies of the treatment records from the last five years. If records are digital, please email them to [email protected], if not please mail or fax. Date of Last NP Exam Date of Last Recall I hereby release my Dental/Medical records and radiographsPatient's/Guardian's Signature * Date* Email*