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Record Transfer Policy


 

The Board of Dentistry Florida Law, 64B5-17.009 states your dental records are the property of Celebrity Smiles. You are entitled to have your dental records transferred or copied as desired. Additionally, duplication and transfer fees will be paid by the patient before any record is transferred. Your fee is calculated based on the cost of standard paper copies, photo paper copies, and standard postage if necessary. Listed is the protocol for having your records given or transferred.

  1. You or representative contact our office for record transfer. Sign our record release form.
  2. We calculate fees and notify you or your rep.
  3. We wait for your duplication fee payment.
  4. Payment received.
  5. We provide or send your records.

I understand the duplication fee payment is required before any release of record which is supported by Law. The fee applies when records are to be transferred to another dental office, if myself or my representative is given the dental records directly, or by any other delivery method. Fees are determined on an individual basis.

Name: _________________ Sign: _________________
Date: __________________
Record Transfer Policy
Revised: 4/1/09

Location
Celebrity Smiles
2575 W New Haven Avenue
West Melbourne, FL 32904
Phone: 321-209-7525
Fax: 321-821-4803
Office Hours

Get in touch

321-209-7525