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Request to access Orthodontic Medical Records

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Under privacy law, clients have rights of access to their information held about them by this practice. We are pleased to assist in providing clinical information required for your ongoing orthodontic and health care to other health professionals when requested by them on your behalf.

Authorise my orthodontic records to be released to the following parties.

Name of Person or Facility*
Address*
Relationship to Patient*
Phone Number

Please Select all specific documents that apply to your request.


If any further information is required please send an email to our reception team via email customerservice@smileteam.com.au

Date

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By submitting this form, you are agreeing to our privacy policy.