Dental Record Request

The following information is provided for all patients who are requesting copies of their dental records.

Excellent Dental Care Center and EDC keep all records of dental services and radiographs which provided by the clinic.  You may request the copies of your dental record and/or radiographs.  Excellent Dental care Center and EDC require a two- week period for the records to be duplicated.  There is also a fees for these services and the schedule below is in compliance with the Washington State per RCW 70.02.010:

If applied:

                $.91 per page for the first 30 pages

                $.69 per page for all additional pages

                $21.0 clerical fee

                Appropriate postage for shipping and handling.

                $10.0- $25.0 for duplicating x-rays as needed.

The records will not be released until the fees are paid. Fees are subject to change without notice.

Finally, please be advised that making copies of dental records is a separate activity from providing dental services. 

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Patient's Name*:

Requester's Name*:

Last Name*:


Patient/Legal Guardian's Signature*,
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