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Request to access Orthodontic Medical Records

Under privacy law, clients have rights of access to their information held about them by this practice. We are pleased to assist in providing clinical information required for your ongoing orthodontic and health care to other health professionals when requested by them on your behalf.

Authorise my orthodontic records to be released to the following parties.

Name of Person or Facility*

Address*

Relationship to Patient*

Phone Number

Please Select all specific documents that apply to your request.

OPG x-ray Lateral Ceph x-ray Clinical photographs

I understand that I will not be permitted to remove the original contents of my record from the premises of the practice, nor will I be permitted to alter or erase information contained in the record.

If any further information is required please send an email to our reception team via email customerservice@smileteam.com.au

Date

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Wollongong

149 Princess Highway
Fairy Meadow
NSW 2519

fairymeadow@smileteam.com.au

(02) 4220 5300 Get directions

Shellharbour

10 College Avenue
Shellharbour City Centre
NSW 2529

shellharbour@smileteam.com.au

(02) 4295 9100 Get directions

Southern Highlands

46 Station St,
Bowral
NSW 2576

bowral@smileteam.com.au

(02) 4861 7076 Get directions

Parramatta

13 Grose St
Parramatta
NSW 2150

parramatta@smileteam.com.au

(02) 9688 3588 Get directions

Drummoyne

204 Victoria Rd,
Drummoyne
NSW 2047

COMING SOON

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Burwood

201 Burwood Rd,
Burwood
NSW 2134

COMING SOON

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