Requesting Patient Records
In accordance to federal and state law (Health Insurance Portability and Accountability Act), copies of dental records will only be issued after a written request from the patient/legal guardian is received by the College.
Download Form Here:
Authorization for Release Health Information Form (English)
Authorization for Release Health Information Form (Spanish)
Once the form is completed and signed, it should be returned to the Office of Registration and Records (Room 103) or via fax at (312) 413-0947.
Please allow 7 business days for processing.
Processing fees, as defined by Illinois State Laws, may apply. Unless specific documentation is requested, copies of records consist of an abstract which usually includes all electronic treatment notes, x-rays and signed consents.
Additional Forms
Patient Audio/Video & Marketing Communications Consent Form (English)
Patient Audio/Video & Marketing Communications Consent Form (Spanish)