Transfer Records

To help ensure seamless care, we can securely send your dental records to another provider or request records from a previous office on your behalf. To meet HIPAA privacy requirements and protect your personal health information, a signed Records Release Authorization Form is required before any records can be released or requested. Our team is happy to help with the transfer of records to or from our office.  To get started with the transfer process, please complete and submit the form below.

    Authorization to Release

    Dental Information





    Release To:

    Vibrant Dental Company

    frontdesk@vibrantdentalcompany.com

    Information Requested

    Purpose / Need for Information

    Authorization

    I certify that this request has been made voluntarily and that the information given above is accurate to the best of my knowledge.