Transfer of files

 For transfer of file or elements please print the form, after filling it mail or drop it to the clinic, and for the urgent cases the form can be scanned and emailed to centrebellesdents@gmail.com
Note that inactive files are archived and patient or guardian signature is required for their release. Reasonable fees for transfer of files, duplication of X-Rays, models, photos/etc. and delivery charges are charged.

Please, describe your request

 

Patient signature:……………………………………………………………………

© 2018