"Our little girl who was at one time absolutely terrified of going to the dentist for a simple cleaning now looks forward to going because your staff has consistently shown her that dental appointments don’t have to be scary… they can be fun!"

Pamela B.

Authorization for Release of Dental Records

There are many reasons why people may need copies of their dental records.  Regardless of the reason, we would be more than happy to assist you.  We can provide your records in many formats so please let us know what would be convenient for you.  In addition, all record requests must be accompanied by a completed release form.  You can download the form using the button below or by requesting in person at our office.  When picking up the requested records, you may also be asked to present a photo I.D. upon request.   Please allow 7-10 business days for our Business Team to process your request. 

If you have any questions or concerns about this process, please do not hesitate to call us at 317-598-9898 or email the business team at

Authorization for Release of Dental Records (PDF)


© Fishers Pediatric Dentistry. All Rights Reserved
9126 Technology Lane, Suite 100
Fishers, IN 46038

Phone: 317-598-9898 | Fax: 317-596-9659
Located near I69 and 116th Street, behind Super Target.
Map and Directions  |  Hours  |  ( Freedom )