LCIAD Patient request for transfer of clinical records

Please complete this form if you would like LCIAD to send a copy of your patient records to a third party or would like to see what data we hold for you. A copy of all clinical data we hold for you will be securely sent via a We Transfer download link to the email address you have requested below. Any models or laboratory work can be posted by recorded delivery upon request for a nominal covering charge or collected from the practice by the patient. Each patient over the age of 16 should complete a separate copy of this form. Parents or guardians should complete a separate copy of the form for each child under the age of 16 under their care. Please note that it is not permissible for LCIAD to delete clinical data held for patients attending LCIAD in line with our obligations to maintaining GDC Standards for the Dental Team – Standard 4.1.

Dr Koray Feran BDS MSc FDSRCS
Principal Dental Surgeon and Clinical Director
The London Centre for Implant and Aesthetic Dentistry Ltd (LCIAD Ltd Company No. 6639132 Reg. 07/07/2008)