Dental Record Release Form

This page provides all Metro Smiles patients with a way to digitally fill out their dental records release forms.

I hereby authorize the release of my digital dental radiographs and periodontal charting to the following Recipient:

Metro Smiles P.C.
Dr. Robin Asbury
8200 E. Belleview Ave., Ste 460E, Greenwood
Village, CO 80111
(303) 768-8443

Please provide the email address of your new dental office.
What is the patient's email address?
Patient Name(Required)
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For any and all questions, please contact our office at (303) 768-8443.
This field is for validation purposes and should be left unchanged.