Download a Free Xray Release Form Dental Template

If you’ve ever tried transferring dental records, you know it’s not as simple as grabbing a manila folder and heading out the door. Especially when X-rays are involved. Without proper authorization, your dentist can’t legally send those images anywhere. That’s where a simple tool comes in handy: the xray release form dental template.

Whether you’re switching dentists, seeing a specialist, or just want a copy of your dental X-rays for your personal records (hello, organized patients), this form helps you do it the right way — fast and headache-free. And yes, we’re offering a free, printable version so you don’t have to reinvent the wheel.

Let’s break it down.

What Is a Dental Xray Release Form?

A dental xray release form is a short, easy-to-fill document that gives your dentist written permission to send your X-ray images to another provider or to you. Think of it as a permission slip for your teeth.

Without this form, dental offices can’t legally release X-rays due to privacy laws. Even if you ask nicely, their hands are tied. That’s why this simple paperwork matters — it protects your privacy while ensuring your new dentist (or orthodontist, endodontist, oral surgeon... you get the idea) has the info they need to care for your smile.

Typically, this document includes:

• Patient’s full name and contact info

• Name of the dental office releasing the X-rays

• Name of the recipient (person or office receiving the X-rays)

• Description of what’s being released (X-rays, dental records, or both)

• Patient signature and date

That’s it. Short and sweet.

Why You Need an Xray Release Form Dental Template

Now you could try writing a dental xray consent form from scratch. But why make life harder? Using a ready-made dental records release template saves time, ensures you include all necessary details, and keeps the form looking professional (because yes, some dental offices won’t accept a scribbled note on scrap paper).

Here are a few situations where this template is super helpful:

• You’re moving and changing dentists

• You’re seeing a dental specialist for treatment

• You want a personal copy of your dental X-rays

• You’re switching to a dentist who uses different imaging software and needs original files

In short, if dental X-rays are going from one place to another, a signed xray authorization form smooths the way.

Download Your Free Dental Xray Release Template