Use this form to request release of your previous dental x-rays and chart notes from your previous dentist.
Authorization for Release of Dental Records
"Dr. Jerry Paczkowski is a wonderful, pain-free dentist, willing to rearrange his schedule to get you in when a tooth may be bothering you. He always makes whatever procedure he is doing as comfortable as possible for you. I would recommend Dr. Jerry to anyone, you won't find another dentist or staff more concerned for patients as them."
Dawn L., Two Rivers
"I have been using this dentist since I was a freshman in high school. I have always been given excellent care, and when I got married my husband and four children have all recieved great oral health care. Now my grandchildren, another generation, are recieving all their dental needs by the Paczkowski family. Thank you for your outstanding service! ''
Denise D., Two Rivers
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