Request Your Dental Records

Patients can obtain their dental records by completing the Records Request Form or having their dentist submit a request on their behalf.

For Patients

Steps to Request Your Records:

  • Complete and sign the Records Request Form.
  • Submit the form via:
    • Fax: 828-522-9966
    • Email: southmountainfamilydentistry@gmail.com
    • Mail:
      South Mountain Family Dentistry
      600 Malcolm Blvd
      Connelly Springs, NC 28612
      Attention: Dental Records Department
    • Hand-delivery to the office

Fees

Fees are applied if the patient would like their records to be sent to them directly. A request for records to be sent to a dentist’s office is free of charge. Fees must be paid in full before records can be released.

Method Fee
Email $6
Mail $10
Certified Mail $20
Email + Mail + CD/X-rays $20

Payment: Call 828-522-9995 to pay. All fees must be paid before records can be released.

Processing Time: Up to 30 days.

Dental Records Release Form

For Providers (Other Dentists)

  • Requests must be on provider letterhead.
  • Submit via Fax or Email:
  • Sending records to a dentist’s office is free of charge.
  • Processing Time: Up to 30 days.

Notes

  • All fees must be paid before records can be released.
  • Requests sent directly to patients incur fees; requests sent to providers are free.