Forms

Prior to your first visit with Dr. Gut you can print, fill in the required information and bring the following forms with you. This will save time and allow us to help you process any claims.

Please alert the office if you have a medical condition that may be of concern prior to surgery (i.e. diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.) or if you are on any medication (i.e. heart medications, aspirin, anticoagulant therapy, etc.)

X-Rays: if your previous dentist has taken x-rays, you may request that they will be forwarded to our office or you can bring them yourself. If additional films are necessary, they will be taken here at Heritage Dental.

 

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