Records Request Form
 
I authorize 
(current healthcare provider)  to release my child's dental record(s) to Sierk Children's Dentistry; for their upcoming dental examination.  
 
Please forward most recent xrays to: FrontDesk@SierkPD.com
 
If we can assist further, please contact us at 303.865.4066
 
Thank You
Jonathan D. Sierk, DDS