Record Release Form

Dental Records Release Form Beenleigh

Before continuing, I understand that in requesting a copy of my dental records, the records will be:

• The records will be emailed and/or posted to my nominated address.
• Receiving by email may not be as secure as receiving the records personally or by post.
• Beenleigh Marketplace Dental accepts no liability for your records once they leave our practice.
• Beenleigh Marketplace Dental accepts no liability for the records if they are accessed by an unauthorised source during transit, or in any other manner whatsoever.
• I can ask for a copy of my records to be provided to me personally or by post if I am sufficiently concerned about email security.
• If I have any further questions, I can contact Beenleigh Marketplace Dental via phone or email.