Typodont Patient Clean-Up Form

Please complete the fields below to request removal of typodont images. Requests may take a minimum of one week to complete, as processing times vary based on total number of requests received.

To receive status updates regarding processing time-frames, please check the Track-It! Self-Service portal at ulsdhelp.louisville.edu following submission of this form.

Contact/Typodont Information

Your E-Mail Address

Your Name:

Typodont Name

Typodont Chart #:

Please indicate the type of request:

Request Type

Please indicate the type of request:

Delete ALL
Delete SOME

Series Details

Please list series to KEEP (if any). On separate lines, please list the name, date, time, and number of images contained for each series you wish to keep (i.e. BW2, 1/29/2016, 7:46 AM, 2 imgs).

Please list series to DELETE (unless all). On separate lines, please list the name, date, time, and number of images contained for each series you wish to delete (i.e. BW2, 1/29/2016, 7:46 AM, 2 imgs). If you would like all images deleted, except for those listed in the section above, type "Delete everything else." in the space below.

Desired Completion Date

Year/Month/Day

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Typodont Patient Clean-Up Form

Please complete the fields below to request removal of typodont images. Requests may take a minimum of one week to complete, as processing times vary based on total number of requests received.

To receive status updates regarding processing time-frames, please check the Track-It! Self-Service portal at ulsdhelp.louisville.edu following submission of this form.

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