Release Forms
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Authorization to Release Dental Information Form
A dental authorization to release information form is used by medical practices to collect information from patients that will permit their dental information to be transferred between facilities. For example, it can be used to establish that a dental provider can release information to a health care provider. A dental information authorization form allows patients to authorize the release of their dental records to a third party. Use this free Authorization to Release Dental Information Form as a model for a security authorization in your office.
Make this form your own by adding your logo, changing the colors or fonts, or adding your own questions to the form. Jotform’s free Form Builder lets you customize the template, so you can share it with patients or collect responses however you need. If you’re worried about a breach in security, Jotform helps you comply with HIPAA, keeping your patients’ files safe from any outside parties. And with Jotform’s 100+ integrations, you can quickly transfer submissions to your other accounts, send them to a wide variety of storage platforms, and more. With Jotform, you can collect the health records you need from patients with a free dental information authorization form.