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  • Home
    • Dental
    • Gynaecology / Pregnancy
    • Dermatology Skin Care
    • Psychiatry
    • General Practitioner
    • General Practitioner 2
  • Our Practice
    • Our Practice
    • Testimonials & Reviews
    • Schedule
    • Blog
  • Get Care
    • Get Care
    • Urgent Care
    • Primary Care
    • Lab Tests
    • Annual Wellness Exam
    • Pediatric Care
    • Virtual Care
  • Providers
  • Patients Info
    • Billing & Insurance
    • Contact & Location
Urgent Care 24h
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+ 1 541-754-3010

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+ 1 541-754-3010

Online Forms

Here are some important forms you to review and complete prior to your appointment with one of our physicians or provider.

  • Screening Checklist for Visitors
  • New Patient Enrollment Form
  • Medical History Form
  • Online Doctor Appointment Form
  • Psychiatric Evaluation Form
  • Quick Emergency Contact Form
  • Blood Donation Form
  • HIPAA Privacy Restriction Questionnaire
  • Medical Release Form

We specialize in fabricating orthodontic appliances such as TMJ Splints, Flippers, and Retainers, as well as all types of functional appliances such as Herbsts, Bionators, and Twin Blocks.

623-879-6066

Dental Appliance Requests

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Address:

 

Phone:

Office Hours:

1745 W. Deer Valley Road
Building 1, Suite 112
Phoenix, AZ 85027

623-879-6066

Mon-Fri / 8am-5pm

 

1745 W. Deer Valley Road
Building 1, Suite 112
Phoenix, AZ 85027
AZ Phone: 623-879-6066

 

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623-879-6066

Gergen’s Orthodontic’s

 

Office Hours
Mon-Fri / 8am-5pm

1745 W. Deer Valley Road
Building 1, Suite 112
Phoenix, AZ 85027

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