Dental Record Request
How to Request a Copy of your Dental Record (Protected Health Information)
To obtain a copy of your dental record, you should submit a signed and dated Dental Record – Authorization Form with payment. Dental records can include medical history, pathology, radiology, lab reports, and other sensitive information such as genetic testing, sexually transmitted diseases, and HIV test results, etc. and are further protected by federal laws. Therefore, if you would like such information to be released, you must specifically indicate so on our authorization form by initialing the respective category of information.
Dental Record – Authorization Form
Dental/Medical Record—Authorization Form for Oral Surgery Group Practice
Contact Information for Division of Dental Records
Phone: 617-638-4710
Fax: 617-638-4764
Business Hours
Monday–Friday, 8 a.m. to 5 p.m.
You may mail, fax, or hand-deliver your authorization to:
Boston University Henry M. Goldman School of Dental MedicineDivision of Dental Records
100 East Newton Street, G-16C
Boston, MA 02118
Please be advised that there will be a charge associated with copying your request; you should allow 3-4 weeks for processing. We will do our best to respond to your requests within a timely manner. The Division of Dental Records can be contacted at 617-638-4710 or you may visit us during regular business hours to make special arrangements, if your request is urgent. Your dental information can also be sent electronically instead of having us mail it to you. Regardless of the option you choose, please be sure to send or bring valid photo identification with you for release of the records.
If the patient is a minor or is not competent, documentation of legal representation is needed. For deceased patients, the request for dental records must be submitted with documentation proving you are the patient’s next of kin (death certificate with name of informant or probate document assigning administrator). Addition information may be required for these requests.
If you are calling after hours, please leave a message and your call will be returned promptly on the next business day.
