• 750 Central Avenue Suite K, Dover, New Hampshire 03820 | 603-743-6000

  • Records Release/ Request

  • hereby authorize the release of my child’s or my own dental records to/from:

  • Dover Pediatric Dentistry & Orthodontics
    750 Central Ave., Suite K
    Central Commons Dover, NH 03820

    Tel: (603) 743-6000
    Fax: (603) 516-5690

  • If releasing records to another office:

  • Clear
  • Should be Empty: