• Records Release Form

  • **Please submit separate form for each patient**

     

  • Patient Information

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    Pick a Date
  • Requesting Records From:

  • By signing this form, I give Oak Grove Dental Center permission to obtain any and all medical and/or dental records needed for my treatment.

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  • Oak Grove Dental Center

    2250 SE Oak Grove Blvd Ste A

    Oak Grove, OR 97267

    Phone: 503-654-9521

    Fax: 503-654-1695

    Email Records to: Shannon@ogdental.com

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