Records Request Form for Adults
Use this form to request a copy of your records if you are an adult.
To submit the form, send it to:
University of Louisville School of Dentistry
Records Request
501 S. Preston St.
Louisville, KY 40202
Or, email it to DentalCA@louisville.edu
Form 09HIP Request to Access Inspect and Copy PHI (for adult patients).pdf
—
PDF document,
149 KB (153298 bytes)
