(613) 395 – 2800 Dr. Lauren Allen | Dr. Ross Erwin | Dr. Marilyn Kandala info@stirlingdentalcentre.com

Transfer of Records Form

The following information is required to obtain any relevant dental records from your previous dental office so that we are able to provide you with the best continuity of care.

Transfer of Records

  • Stirling Dental Centre

    9B Tuftsville Rd., Stirling, ON, K0K 3E0, Phone: (613)395-2800 | Fax: (613)395-2808 | Email: info@stirlingdentalcentre.com
  • Previous Dental Office

  • For each patient to be transferred, please include dates of most recent: Initial exam, recall Exam, Scaling/Polish, BW, and PAN. Please forward most recent digital radiographs to: info@stirlingdentalcentre.com
  • MM slash DD slash YYYY