Dental Records Requests


All requests must include the following:

  • Patient’s full name
  • Date of birth
  • Verification of Indentity (Driver’s License, ID Card, Passport, etc.)
  • Name, address, and telephone number where the records are to be sent
  • Purpose of the request
  • Specific items or dates of service needed
  • Any restrictions on the request
  • Date of the request
  • Signature of the patient or, if the patient is a child, the parent or guardian
  • Date this authorization expires (authorizations must be less than one year old)
  • If signed by a personal representative, a description of his/her authority to act for the individual and a copy of the document giving that authority.

Email request to:

Fax request to:

  • (352) 273-5344

Mail request to:

  • University of Florida – College of Dentistry
    Dental Records
    P.O. Box 100425
    Gainesville, FL 32610-0425