3 Harwood Ave South. Ajax, Ontario, L1S 2C1

To book an appointment or learn more please call: (905) 686 4343

Dr. Joe Miskin
3 Harwood Ave. S
Ajax, Ontario L1S2C1
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Date: _________
Dear Doctor ________________
Re: Record Transfer

We are currently treating ________________________ a former patient of your practice. This correspondence authorizes your office to release all dental records to the above noted dental office.
Thank you for your timely response.

Dr. Joe Miskin DDS

RCDS guidelines state: The release and/or transfer of patient’s records and radiographs is required under Ontario Regulation 853/93 made under the Dentistry Act, 1991.

Our dental team of Dr. Joe Miskin, Linda, Gail and Sarah are here to help you have a positive dental experience. If you have any questions or comments please call us at 905-686-4343 or email our Office Manager, Linda at linda.miskindental@gmail.com

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Dr. Joe Miskin
3 Harwood Ave South.
Ajax, Ontario
L1S 2C1


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