X-Ray Form Form

Dental Radiograph Release Form
Today's Date*
Previous Dental Office Name*
Previous Dental Office Phone*
Consent
I hereby authorize the release of my family's dental radiographs from my previous dental clinic so that they can be transferred to North Stony Dental.
Panorex within the last 5 years
Bitewings within the last 2 years
Periapical radiographs within the last 2 years
Patient Name*
First Name Last Name
Patient Date of Birth*
Signature*

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North Stony Dental | Dentist in Stony Plain, Alberta 4300 S Park Dr #270, Stony Plain, AB T7Z 2W7 info@northstonydental.com (780) 968 4414 Directions

North Stony Dental is a family and cosmetic dental clinic. We provide orthodontic services such as Invisalign, Braces, and Myobrace. We are located in Stony Plain across the street from Safeway. New patients welcome, evening and weekend appointments. We are a dental clinic in Stony Plain conveniently located close to Spruce Grove and Parkland Village.

Why Choose North Stony Dental?

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Our Hours

Day of the Week	Hours of Operation
Monday	8:00 AM–4:00 PM
Tuesday	8:00 AM–4:00 PM
Wednesday	9:00 AM–6:00 PM
Thursday	9:00 AM–6:00 PM
Friday	8:00 AM–3:30 PM
Saturday	Closed
Sunday	Closed

Closed on holidays and long-weekends.