Merchant's Walk Dental

Request Your X-Rays

Need a copy of your dental x-rays? Fill out the form below and we'll send them directly to you within 1–2 business days.

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Patient Information

X-Rays Requested *

Select all that apply.

Reason for Request

Where Should We Send Them?

We'll send your x-rays digitally to the email address you provide below.

Your information is submitted securely and handled in accordance with HIPAA privacy regulations.