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Request For Records
8321 KENNEDY RD. UNIT # 22. MARKHAM, L3R 5N4
905.470.4289
Dr Name
Pataint Name, has/have recently become a patient/patients in my practice
Would you kindly forward the following records
Radiographs
Panorex
Charting of existing oral/dental conditions
Notes of your treatment
Any notes from referring specialists
Misc.
Message
All of the above will be kept indefinitely should you require them in the future.
Thank you.
Date
Send
