Consent for Records Release (text only)

Please read this Consent for Records Release below and sign the English version at https://mdvdds.com/rr-consent

Spanish, Arabic and Persian versions are available by making a selection on the flag at the top right of this page.

If you have any questions call us on (615) 915-6090.

Please send dental and health history records as well as ISP and Risk Tool information for:

Patient name

Patient date of birth

To:

Dr. Michael D. Vaughan, DDS and Associates
Triax Dental

330 Wallace Rd, Ste 106
Nashville, TN 37211

e-mail: records@triaxdental.com
fax: (615) 915-6091

Please sign the English version at https://mdvdds.com/rr-consent

If you have any questions call us on (615) 915-6090.