Dental Records Release – Brock Starr Dental Care

Dental Records Release

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Name

First

Last

Date of Birth

Phone number

Other family members to transfer

Dentist Information

Previous Dentist or Practice Name

Address

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City

Province

Postal Code

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Phone Number

Fax Number

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Information Requested

Copy of complete dental chart
Copy of dental x-rays
Other (models, etc - provider details)

Dates Covered

All treatment rendered in previous office
Limited to treatment dates and for conditions described below

Purpose(s) or need for which information is to be used

Transfer of records
Referral (oral surgeon, orthodontist, endodontist, etc.)
Other

Name and Email of Signing person

Label

I hereby give you permission to release any and all of my dental records to Brock Starr Dental Care.

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First & Last name

Email Address

Current Date (Dentist)

DD/MM/YY

Signature

evening_and_weekend_appointments

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payment

What our patients think

Hanna

“This office treats everyone like family and provides all of their patients with the utmost care and patience.”

Alex

“Excellent customer service with a caring and friendly staff.”

Connor

“They were fabulous. Absolutely blown away by the service.”

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Contact Our Office

Google Rating

4.9

Based on 737 reviews

BrockStarr Dental Care

4.9

Kelley Gaspar

Great Staff! Dr. Sameri has the gentlest hands...just like a butterfly. You don't even know she is working. Helen has been my Hygenist for years. She is thorough and gentle but the cleaning work is awesome! And I can't forget Tina - always a pleasure to hear her voice greet me. We are now three generations in 💕

William Whyte

The team at Brock Starr Dental have always been friendly and professional and I recommend them as a great place for all your dentistry needs!B. Whyte

Rebecca Eagle

Abigail Stewart

Cassie and Dr. Sameri are wonderful! I have been going here since 2011. I appreciate Cassie’s kindness, thorough skills and friendly nature. She always makes me feel some comfortable. The same goes for Dr. Sameri. I can’t recommend them enough.

Dice Bryars

Samantha Della camera

Dr. Sameri and her team are truly one of a kind. She’s incredibly skilled, but what sets them apart is how caring and thoughtful they all are. They always take their time, explain things clearly, and make sure you feel comfortable every step of the way. I’ve never felt rushed or judged — they genuinely listen and treat you like a whole person, not just a patient.Highly recommend to anyone who wants a dental team that truly cares.

Keyvan Hm

Phil Grenfell

Jenn is a great person love the conversation and very polite

Mohamad Ajdarpour

Best dental office in our town 👏👏Dr Sara is one of the best dentist’s I’ve ever had the privilege of being treated by.Her receptionists and dental assistants are all so kind and helpful.

sharifunnesa rumi

That was an amazing experience in this place. My kids loved it.

alissar el sayed

Dr Sara is an amazing doctor. It’s not my first experience at her clinic and won’t be the last. You are not only dealing with a doctor but also with an amazing human!

Ken Downey

Been going to Brock Star since it opened and I've always had the best experiences. Thanks for all these years

Sandile Ngwenya

I came in for a tooth filling and had an amazing experience with Dr Sarah Samari, she was super kind. I would definitely recommend!

Alexandru Nitu

Cecilia Bolt

Debra

It's been many years at Brock Star Dental with Dr. S. Sameri as my dentist who is very professional and any procedures have been always pain free, it's a pleasure to sit in her Dental chair. And my Dental Hygienist Cassie is a gem, very gentle and throughly keeps my teeth in perfect condition. D

Sayeh Hadianfar

Monika Naumovski

Amazing! Everyone here from the front desk to the dentists are so welcoming and lovely. Best dentist place I've ever gone to, been coming here for 4 years!

jesseca duncan

The dental team are all incredibly friendly and informative!

Filiz Seyitler

I had an amazing experience at BrockStarr Dental! From the moment I walked in, the front desk was friendly and helpful.Dr. Sameri and her Dental Hygienist Raj made the whole process smooth, ensuring I felt comfortable throughout the procedure. The customer service was top-notch! Thanks so much ladies!!

Jeremy mi

Gabor Burkus

Jane SM

Great experience The dentist were really friendly and explained everything. The admin was super nice, very knowledgeable and organized

Miah Butler

FERGUS FERGUSON

Matt Massie (Brimfull)

Brockstarr dental is so nice and accommodating. Dr Sameri is so nice and gental, she is so personable you actually feel like a valued customer. I would highly recommend this Dental office.

Jack Graham

Amazing cleanings, amazing dentists, and everyone is always nice. For the 10 years I have attended I have never had one bad experience!

Leslie Goodall

We travel 100 km to visit Dr Sameri. She is kind, caring and gentle. She’s always concerned with your comfort. Have been with her 24 years now and wouldn’t go anywhere else. A+++++

Rebecca Phinney

Welcoming environment. The team members that I have interacted with have been top notch.

K Mac

Tina and Sara are great would reccomend coming here my teeth have never felt cleaner

Saba Ghafari

I have recently visited brockstarr dental care for dental cleaning and examination.My experience was great. All the staff were very friendly and professional.My hygienist was very gentle and efficient and the dentist was very knowledgeable.highly recommend!

Fataneh Shadfar

The staff and doctors are amazing here!The office is very clean with ample parking!highly recommend!

tanaz mortazavirad

highly recommend this place to everyone in needs of dental care!

uzumaki naruto

😬🫵🏼👍🏼

Abhilesh Dangol

I had a great experience at the clinic today. The dentist and her assistant Dr Sameri and Rach was thorough and explained every step of the procedure, making me feel comfortable. The staff was friendly, and the clinic was clean and well-organized. Highly recommend!"

Stephanie S.

After moving to Whitby 10 years ago I finally switched dental offices and was very hesitant to do so. Dr. Sameri and her team are lovely and made the switch easy! The office is clean and everyone is very friendly and makes the experience a great one! Definitely would recommend BrockStarr Dental!

Sanjay N

Dr. Sara Sameri and everyone at BrockStarr Dental Care are an amazing bunch with a wealth of expertise. I have confidence and trust in the services they render.

Peggy Salmon

I have been with this dental office for decades but at each visit with Helen the hygienist or Dr. Sameri I am impressed with the professionalism, speed and friendliness of them and all the staff at Brock Starr Dental! Highly recommend.

Yongsong Liu

Very friendly and helpful. Thank you

Veronika Balazic

Very friendly and efficient… always a good experience

Jannessa

Наталия Бекишева

justin groeger

Love coming here, Dr Sameri is so sweet. Also shoutout to Cassie. Always a great time.

Roberta Bone

Chris Arnburg

I personally have always had a great experience with the staff at BrockStar Dental Care and the care provided can’t be better. Crazy as it sounds, my 4yr & 6yr olds look forward to their dental appointments. I would recommend BrockStar Dental Care to anyone.

Mats Johansson

Super friendly and polite staff - very professional! Would highly recommend 👍😃

Daniela Dobbie

Dr Sarah is amazing She’s kind, caring and compassionate. She treats you like one of her own children. I struggle with anxiety and I’ve been dealing with teeth issues for many years. Dr. Sarah makes me feel at ease comfortable and safe. I couldn’t ask for a better dentist. She is wonderful.

iinoubliable

The best dentist in the world !! They have got me right since I was 8

Cori Peachez

#1 for any dental emergencies‼️My husband had a serious dental problem, swelling, constant pain. He couldn’t eat & it was effecting his sleep & work.Brock Star was able to get him in that day( where his dentist couldn’t for a week) they figured out the problem and fixed it.He is not a fan of the dental pain but even he was impressed with their “no pain”!We both recommend Brock Star dental to anyone. Not only for their work but also the people are so nice & polite, even to each other. Made my husband comfortable and calm through the whole process.Thank you Brock Star family🤗

Tasneem Sumaiya

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