Patient Forms :


  

All Patients who have an ACTIVATED Power of Attorney (POA) or a Legal Guardian  > STOP !!

Contact our office immediately before proceeding & downloading the Forms

If patient does not speak/read English or fully understand the English language  > STOP !!

Contact our office immediately before proceeding & downloading the Forms

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CLICK HERE : to print the Recertification Pack  ( Existing Patients Only )

 

 

Patient Forms.  This website is for informational purposes only and is not a substitute for Dental or Medical advice, diagnosis, or treatment.  The information on this website does not create a patient-dentist relationship, and should not be used as a substitute for professional diagnosis and treatment.  By visiting this site you agree to all its terms and conditions, which may from time to time be changed or supplemented by Dr. James J. Herget listed in the Disclaimer.  If you do not agree to these terms and conditions, you should not enter this site.