Dental Information Release
In Lansing, Ann Arbor and Brighton, Michigan

When you become a patient of Dr. DiStefano and Dr. Nguyen, it is necessary for us to obtain your dental health records from the dentist(s) you have worked with in the past.

This is important because we need to be aware of all restorative and cosmetic dental procedures you have had done and all conditions that you have been treated for before we can diagnose you or recommend additional treatments. With this information, our cosmetic dentists are able to ensure you will get the best care possible, specifically suited to your dental needs and history.

Please provide us with your previous dentist's information and we will obtain your records using the form below.

• Notice of Privacy Practices: HIPPA Brochure given to patients at a consultation appointment regarding disclosure policies

" The dental procedures we specialize in enhance our
patients' look and their quality of life! "

If you are located in the Lansing, Michigan areas and would like to schedule a consultation, please contact us now. We are committed to providing all of our patients in the Michigan area with the very best services and procedures available in family and cosmetic dentistry.