Please use the following form to request additional information or leave comments for the University of Iowa College of Dentistry & Dental Clinics.

Select the appropriate category:

Patient Care / Appointments
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My Dental Portal / Online Patient Portal
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Are you requesting dental records?

We will need to have you sign and return a consent to release your records.

Please download, print and complete this form. Consent release health info

The completed and signed form must be returned to process your request.

The completed form may be returned to the College of Dentistry Central Records by

fax: 319.335.7417
email: dent-crec@uiowa.edu
US mail:   College of Dentistry
                Attn: Central Records
                801 Newton Road
                DSB N203
                Iowa City, IA 52242

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