Patient Information

Dentistry on Parkside provides a premiere service, delivering
results of the highest quality in a relaxing, modern environment

Request & Consent for Records Transfer

 

To transfer your records to another person or organisation, please complete the below form. if you have any questions please feel free to call us on 03 308 7472

If you would like to arrange a consultation, or simply wish to know more about our dental clinic services in Ashburton, please Contact Us.

Please transfer my dental records, treatment history and radiographs.

Please send my records to the following person/s:









Authorised consent:


I agree