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 Authorization to Disclose Dental Records Form (links to forms are located below). 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.

English Authorization to Disclose Dental Records Form (EN)
Español Authorization to Disclose Dental Records Form (ES)
Português Authorization to Disclose Dental Records Form (PT)
Français Authorization to Disclose Dental Records Form (FR)
हिंदी Authorization to Disclose Dental Records Form (Hindi)
Kreyòl Authorization to Disclose Dental Records Form (Haitian Creole)
中文 Authorization to Disclose Dental Records Form (Chinese)
Kabuverdianu Authorization to Disclose Dental Records Form (Cape Verdean Creole)

Contact Information for Division of Dental Records

Phone: 617-358-3403
Fax: 617-358-0327

Business Hours

Monday–Friday, 8 a.m. to 4:30 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
635 Albany Street, G-603A
Boston, MA 02118

You should receive your records in approximately 1-2 weeks. We will do our best to respond to your requests within a timely manner. If your request is urgent, the Division of Dental Records can be contacted at 617-358-3403, or you may visit us during regular business hours to make special arrangements.  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 as soon as possible.