Request For Records

8321 Kennedy Rd #22, Markham, ON L3R 5N4

(905) 470-4289

Dr Name

Patient 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