Dental Records Release Form
Request For Release Of Dental Records



Email the most recent Pan and/or Bitewings to:
[email protected] (in a .jpeg format)

*Please include the Name of the patient and the date of the x-ray(s) with the email.
*If email capability is not available, then please mail the x-rays to: 
29795 Three Notch Rd Charlotte Hall, MD 20622


Patient(s) Name:



Contact Us
Charlotte Hall, MD Pediatric Dentist
Tender Care Dentistry
29795 Three Notch Road
Charlotte Hall, MD 20622
(301) 298-2622
(301) 290-5633 fax
Charlotte Hall Pediatric Dentist Call For Pricing