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Record Release Form

In order for our office to receive your current dental records a record release form needs to be completed. Please fill out the form below. Once the form is completed, submit a copy to your previous dental office. The records may then be sent to Dr. Heather Blanchard.

Records Release Form

If you are a current patient of Dr. Heather Blanchard’s dental office and would like your dental records transfered, please fill out the form above and send a copy to our office. As soon as we receive the completed form, we will forward the dental records to your new office.