Dental Records

Contact Us

For questions regarding the process to request a copy or authorize the release of your health records, please contact:

Custodian of Records
(310) 825-3195
Fax: (310) 825-7620

aambriz@dentistry.ucla.edu

Patients are entitled to copies of their current dental records, as per the Patient Bill of Rights. To protect the confidentiality of your dental records and before we can release your dental records, you must provide written authorization.

Authorize Release or
Request a Copy of Records

For your health records to be released to yourself or an outside party, an Authorization form (hard copies only) must be completed and returned. Records can only be sent by hard copy but radiographs may be sent by hard copy or emailed digitally. Please fax the completed Authorization forms to the appropriate clinic where you are making your request.

Please put “Attention Custodian of Records” on the cover of your fax. Fax numbers for each clinic can be found below.

Please complete and return the following Authorization form to receive electronic communications relating to your health records. 

You may also authorize the release of your radiographs via email, please complete and return this Authorization form (email radiographs only) to one of the clinics below.

Please note that record duplication and/or releasing of records takes 5 to 7 business days and there is a nominal fee associated with the duplication of your records and any radiographs (includes CT scans). 

Clinic Name

Type of Provider

Fax Number

General Student Clinic - Westwood

Student

(310) 825-7620

General Student Clinic - Venice

Student

(310) 392-8513

Advanced Education in General Dentistry

Resident

(310) 825-7620

Center for Esthetic Dentistry

Resident

(310) 825-7620

Children's Dental Center (Westwood Pediatrics)

Student
Resident

(310) 825-7620

Endodontics - Weichman Endodontic Clinic

Resident

(310) 825-7620

Faculty Group Dental Practice

Faculty

(310) 208-0786

Graduate Orofacial Pain

Resident

(310) 825-7620

Graduate Prosthodontics

Resident
Faculty

(310) 206-4201

Hospital Dentistry

Resident
Faculty

(310) 206-4201

Maxillofacial Prosthetics

Resident
Faculty

(310) 206-4201

Oral and Maxillofacial Surgery

Student
Resident
Faculty

(310) 825-7620

Oral Medicine Faculty Practice

Faculty

(310) 825-2124

Oral Radiology

Faculty

(310) 825-7620

Orofacial Pain Faculty Practice

Faculty

(310) 825-2124

Orthodontics - Thomas R. Bales Orthodontic Clinic

Resident

(310) 825-7620

Postgraduate Periodontics and Implant Surgery

Resident

(310) 825-7620

Straumann Surgical Dental Clinic

Resident
Faculty

(310) 825-7620

Wilson-Jennings-Bloomfield UCLA Venice Dental Center

Student
Resident
Faculty

(310) 392-8513