Records Release Form I, the undersigned, __________authorize_________ to release those records, radiographs, or other pertinent information for myself and my family, to my new dentist, whose name appears below.NameName dentistDr AddressDr. Bahareh BehfarArdagh Family Dentistry225 Ferndale Dr. S., Unit #7Barrie, ON L4N 6B9Patient’s Name(s)Patient’s SignatureStart signing your signature hereYour browser does not support e-Signature field.Please indicate the date of each service of EACH patient for all of the following procedures listed and return information by Email : info@ardagh.ca or by Fax: (705) 727-4557Last New Patient Exam/Complete Oral ExamLast Recall ExamLast Bitewing RadiographsLast Panoramic RadiographLast Full Mouth SeriesSend Message