Dental Records
Contact Us
For questions regarding the process to request a copy or authorize the release of your health records:
Westwood:
Marianne Hakopian
Custodian of Records
Tel: (310) 825-3195
Fax: (310) 825-7620
mhakopian@dentistry.ucla.edu
Venice Dental Center:
vdc@dentistry.ucla.edu
Tel: (310) 392-4103
Fax: (310) 392-8513
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 (dental records) 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 | (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 | (310) 206-4201 |
Hospital Dentistry | Resident | (310) 206-4201 |
Maxillofacial Prosthetics | Resident | (310) 206-4201 |
Oral and Maxillofacial Surgery | Student | (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 | (310) 825-7620 |
Wilson-Jennings-Bloomfield UCLA Venice Dental Center | Student | (310) 392-8513 |