Misken Dental Team

Dr. Joe Miskin
3 Harwood Ave. S
Ajax, Ontario L1S2C1
905-686-4343
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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.