Patient Information
NEW PATIENTS: Please print and complete the following forms and bring with you to your first appointment.
Scheduling
Our office hours are:
- State College Office: Monday – Friday 8am until 5 pm
- Altoona Office: Monday – Thursday 8am until 5pm
Emergencies are seen on a daily basis at both offices. It is our goal to accommodate each patient to the best of our ability. When scheduling, please note that most treatment is completed in one visit.
We do make every attempt to minimize your wait time; however, emergency cases can arise which may cause a short delay. Please know we like to spend the necessary time with each patient. Thank you for your patience.
If you need to schedule an appointment or have any questions, please call 814-231-7668 (State College) or 814-201-2298 (Altoona).
What to Expect at Your Appointment
Upon arrival, you will be expected to complete patient registration and medical history forms. In order to expedite your appointment, we ask that you provide the following information at the time of your visit:
- Your referral slip
- Any radiographs from your general dentist
- If applicable, your dental insurance card
Patients can expect to be in our office for approximately 1-1.5 hours. If your treatment requires more time, you will be notified prior to your appointment. Dr. Hertzberg or Dr. Fields uses local anesthetic during the procedure so it is not necessary to have someone accompany you to your appointment. There are also no restrictions prior to your scheduled appointment. After your procedure, Dr. Hertzberg or Dr. Fields will review any instructions with you.
Patient Forms
These forms are for your convenience. Please feel free to print any of these forms, complete them and bring them with you on next visit. Any questions, please call (814) 231-7668. Thank you.
- Notice of Privacy Practices (Hippa Notice) (PDF)
- Dental Registration (Interactive PDF form)
- Patient Consent Form – Privacy Notice Receipt (PDF)
- Health History (Interactive PDF form)
- Financial Policy (PDF)
- Consent for Anesthesia IV Sedation (PDF)
- Dr Josh Medical Clearance (PDF)
- Patient Instructions Following Anesthesia (PDF)