Dental Symphony - Patient Page

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Welcome to our online File Upload portal

Please submit the HIPAA secure form below to send us patient X-rays or other files. You will receive a confirmation email after you have successfully submitted the files to our office.

Patient Information

*First name:

Middle name:

*Last name:

*Date of birth:

*Contact phone:

Contact email:

Colleague Information

(Complete this section if you are not the patient)

Practice name:

Person submitting this form:

Contact phone number:

Contact email:

Upload Files

Drop files here, or click here to upload.

Additional notes:

Welcome to our online File Upload portal

Location Information

Patient Information

Colleague Information

Upload Files

Thank you for submitting files to our office. If you put in an email address, you will receive an email confirming your submission.