Release Of Record Request Form – North Bethesda, MD – Prostho Endo Dental Group

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Release Of Record Request Form

We’re happy to assist you with obtaining a copy of your dental records. To ensure accuracy, security, and timely processing, all record requests must be submitted through the form below and signed by the patient or authorized representative.

How It Works

  1. Complete the online request form below
  2. Choose your preferred delivery method
  3. Submit your request
  4. Once submitted, our team will review and process your request.

Processing Time

Please allow three to five business days for your request to be completed. If additional information, identification, or payment is required, our team will contact you.

Delivery Options

Receive your records through a secure, encrypted email link.

  • Fastest option
  • No cost
  • HIPAA-compliant

 

2. In-Person Pickup On USB Drive ($35 Fee)

Receive your records on a USB drive for pickup at our office.

  • Convenient physical copy
  • Ideal for personal storage or hand-carrying to another provider
  • $35 fee required before release
  • Important: Our office does not accept USB drives from outside facilities due to data security policies. We will provide you with a USB drive from our office instead.

Financial Records

Financial and billing records must be requested separately by emailing: billing@prostho-dent.com

Important Information

  • All requests must be completed and signed by the patient or authorized representative.
  • A valid photo ID is required for in-person pickup.
  • Records for adult patients may only be released to the patient or authorized representative.
  • Requests for minors must be submitted by a parent or legal guardian, unless otherwise permitted by law.
  • Records will be processed in accordance with applicable state and federal regulations.
  • If applicable, our team will contact you regarding any required information before processing.
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