Dental Records Transfer Request Dental Records Transfer Request Already registered with us? Use this form to request your dental records from your previous practice. We'll handle the rest. First Name * First name is required. Last Name * Last name is required. Date of Birth * Date of birth is required. Select your previous dental practice * Select a practice... Acacia Dental Casuarina Square Dental Care Darwin Dental Clinic Darwin Dental Specialists Darwin Orthodontics Dr Chaplin Hsiong Dental Surgery Extreme Dentistry Fannie Bay Dental Surgery Goodlife Dental Studio Grassroots Dental Humpty Doo Dental Hyalite Dental Surgery Karama Dental Family Practice Leanyer Dental Surgery Moil Dental Surgery National Dental Care Darwin National Dental Care Palmerston Nightcliff Dental Surgery Palmerston Dental Surgery Parap Family Dentists Smith Street Dental Top End Orthodontics Trower Dental Your Dentist Darwin Your Smile Dental Other (not listed) Please select a practice. Name of your previous dental practice * Practice name is required. Suburb * Suburb is required. State * Select state... NT QLD NSW VIC SA WA TAS ACT State is required. I authorise the release of copies of my dental treatment records including copies of all relevant x-rays to be transferred to Dr Thien Pham at Compass Dental Care, 102/12 Salonika St, Parap NT 0820. You must agree to authorise the transfer of your records. Signature * Please sign below using your mouse or finger. Clear Signature Signature is required. Submit Request Request Submitted! We'll contact your previous practice and arrange the transfer of your records. This usually takes 1-2 weeks.