X-Ray Release Authorization

Welcome to Shoreline Dental Care LLC. We apprectate your confidence in our dental health team and pledge to provide you with the highest level of professional care possible. In order to help us ensure your health and comfort, we ask that you complete SHORELINE the following form. All formation will be held in the strictest confidence. If you have any questions or require help, please ask DENTAL CARE and we will be happy to assist you.


Patient Name

I hereby authorize and request you to release a copy of any x-rays taken within the last 3 years to Shoreline Dental Care, LLC. (Dr. Joseph D. Tartagni, D.M.D & Dr. Jason Tartagni, D.M.D & Associates)
X-rays can be emailed to: smiles@shorelinedentalcare.com Please email the x-rays in JPEG format and indicate the date(s) taken. If you do not use digital radiography, please duplicate the x-rays to the highest quality possible and mail them to our office.