Not Done Yet!

Autumn Family Dentistry Storefront

Thank you for completing our form for the release of your dental records!

In order for us to release your dental records, you must upload a valid photo ID (such as a driver's license or passport) using the form below.

If you need anything else or have any additional questions, please feel free to contact us directly by telephone during our normal business hours: 281-678-8344 or by email using our website Contact Form.

Upload a Valid Photo ID

Please let us know your name.
Please let us know your email address.
Example Phone Number: 123-456-7890
Please Attach a Valid Photo ID
Please let us know your message.