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Records & Forms

Central Records

Contact information

  • Room B390, 1011 N. University Ave, Ann Arbor, MI 48109-1078
  • For record duplication:  734-764-6152
  • Fax: 734-615-7040

If you would like a copy of your records, we require a release form and a small processing fee.  You will need to download the two-page form below.   Print, complete and return with payment by fax, mail or in person to Central Records.

Sending radiographic documents to Patient Services

  • X-Rays can be sent via email to: Dentalrecordcopy@umich.edu
  • Include patient name, date of birth, referring provider name or clinic and image capture date

Forms

The following forms can be printed and completed by you prior to your appointment to bring with you.

If you are accompanied by a family member or friend and would like that person to be involved in discussing your care, please print, complete and return this form at your next appointment.

Related Links

Student Dental Clinics

In the Student Dental Clinics, treatment is provided by dental and dental hygiene students under direct faculty supervision.

Graduate Specialty Clinics

In the Graduate Specialty Clinics, you will receive treatment by residents training for a graduate degree or board certification in their specialty.

Faculty Patient Care

Faculty members at the University of Michigan devote part of their time to patient care, employing the most advanced diagnostic technologic procedures available. For more information go to Dental Faculty Associates

Related links for Faculty Patient Care