PO Box 949 California, MD 20619
E-mail: [email protected]

Records Release

Instructions

A one-time transfer of clinical records can be made to your current general
dentist or specialty (periodondist/endodontist/implant ) provider with your
permission and signed request. Send this
Records Release form properly filled out and signed with your legible
signature. You must include the name of the dentist, and his/her dental
office postal and email addresses on the form. Email the form to:
[email protected], or mail the records request form to:
Bay Dental Group, LLC
P.O. Box 949
California, MD 20619

If you desire a personal copy of your record be sent to yourself, please
send the signed records request form (this request may be subject to a processing
fee as allowed by law) to:

Bay Dental Group,LLC
Custodian of Records
P.O. Box 949
California MD 20619

NOTE: Please allow 2-3 weeks for processing your request. As of Feb 1, 2021 there is no longer
administrative staff monitoring these sites on a daily basis. Records
requests with improperly filled out Records Release forms will not be honored.