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 (links to forms are located below) 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 (English)

Dental Record – Authorization Form (Spanish)

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 Medicine
Division of Dental Records
100 East Newton Street, G-02
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.