Request for clinical records
Please use the form below to request a copy of your clinical records at TwentyOneDental
Patient Clinical Request
Please complete this form if you would like TwentyOneDental to send a copy of your xrays/scans to a third party and/or yourself or would like to see what data we hold for you.
A copy of your xrays/scans and/or all clinical data we hold for you will be sent via a secure link to the email address you have requested below. Any physical models/laboratory work can be posted by recorded delivery upon request for a nominal covering charge or collected from the practice by the patient. Each patient over the age of 16 should complete a separate copy of this form.
Parents or guardians should complete a separate copy of the form for each child under the age of 16 under their care. Please note that it is not permissible for us to delete clinical data held for patients attending our clinic in line with our obligations to maintaining GDC Standards for the Dental Team – Standard 4.1. (See https://www.gdc-uk.org/information-standards-guidance/standards-and-guidance/standards-for-the-dental-team/).
Dr Adyl M Asani BDS BSc (Hons) London
Dental & Implant Surgeon | Clinical Director