Records Release Consent Form

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Choose Your Doctor

Doctor

Dr Sam Huang
Dr Joon Park
Bob Rho
Nimra Asfar

Existing Clinic Details

Clinic Name

Clinic Phone Number

Clinic Email Address

Your Personal Details

Full Name

Address

Date Of Birth

Phone Number

Consent

I have consented to have my dental records forwarded to Brisbane dental and Denture clinic via email : brisdentalclinic@gmail.com

I would also like the following family members to be included:

Name

Date Of Birth

Name

Date Of Birth

Name

Date Of Birth

I request for you to provide the following:

Records

My dental clinical notes
My X-Rays, scans

Acknowledgement

I acknowledge that the email transmission cannot be guaranteed to be secure and error-free, I release both practices from all liability relating to any data breach associated with the transmission of the records by email across the internet or the security of the recipient’s email account.

Signature

Clear Signature

bris_dental_denture_clinic

Elizabeth St Acacia Ridge 4110

Wondering how long it takes to recover after a den

Wondering how long it takes to recover after a dental implant surgery?

We've got answers to all your questions! From healing timelines to aftercare tips, check out our FAQ to learn more.

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Our lovely patient surprised us with some deliciou

Our lovely patient surprised us with some delicious morning tea today!

We're so grateful for the thoughtful gesture and happy to know we've made a positive impact on their dental journey.

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We recently received an amazing Google review from

We recently received an amazing Google review from a patient who came to us feeling anxious after a difficult past experience.

Thanks to our team, their wisdom tooth removal was quick, easy, and stress-free.

We're proud to provide care that makes a difference.

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Say goodbye to slipping dentures and hello to stab

Say goodbye to slipping dentures and hello to stability!

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Keep your child’s smile bright and healthy with

Keep your child’s smile bright and healthy with our MySmile Membership Program!

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Enjoy every bite with confidence! At Brisbane De

Enjoy every bite with confidence!

At Brisbane Dental and Denture Clinic, our secure dentures are designed to stay in place, letting you savor your meals worry-free.

Book now to experience the difference!

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Thinking about getting dental treatment overseas?

Thinking about getting dental treatment overseas?

It might seem cheaper, but the risks can outweigh the savings. Here in Australia, strict regulations by the Dental Board and AHPRA ensure your safety and quality care.

Choose trusted, local professionals such as Brisbane Dental and Denture Clinic.

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Are you one of these people who might need dental

Are you one of these people who might need dental implants?

Whether it's due to injury, decay, or gaps in your smile, we’re here to help you regain your confidence.

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Ever wondered how we create your custom dentures?

Ever wondered how we create your custom dentures?

Watch our in-house process of designing and milling dentures with precision and care at Brisbane Dental and Denture Clinic.

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Shoutout to our amazing Practice Manager for spoil

Shoutout to our amazing Practice Manager for spoiling us with these delicious treats!

It’s a good day at Brisbane Dental and Denture Clinic.

#grateful #teamappreciation #brisbanedental #AcaciaRidge

Please note that Brisbane Dental and Denture Clini

Please note that Brisbane Dental and Denture Clinic will be closed on the 14th of August 2024 for the Ekka Public Holiday.

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Introducing My Smile Membership Program! Get a br

Introducing My Smile Membership Program!

Get a brighter, healthier smile with our affordable plans. Enjoy a 10% discount on all dental services, making it easier than ever to maintain your oral health.

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