Transfer of Patient Records

 ______________________________________________________________________

Please forward the following: 

1.  Any radiographs that are 2 years old or less.

2.  Copy of the most current Health History.

3.  A copy of all records for the previous 5 years.

4.  Any other pertinent information such as letters from physicians, hospitals, etc. that might pertain to past and future dental treatment.

Please forward the records to:

Marshall T. Snodgrass, D.D.S., P.C.

14303 West State Hwy 38

Marshfield, MO 65706

 

Signature (patient or guardian): ________________________________________

Date: _________________________________________