Designation of Records

This form is to be used by the licensed Texas dentist to designate a custodian of records upon initial licensure and at each renewal period.  Dental records are the sole property of the dentist who performs the dental service, unless otherwise designated per Board rules. Please provide the following information to appropriately designate ownership of records and appointment of a custodian, if necessary.  Upon completion of the form, you may email it to licensinghelp@tsbde.texas.gov.

Designation of Records Form

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