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CRISTIAN JAGER, D.D.S, P.C. 
CERTIFIED IN PROSTHODONTICS 
59 East 54th Street, Suite 91 
New York, NY 10019 
(212)977-6924
(212) 935-6789

I understand that my dental insurance is· a contract between the insurance carrier and me and not between the insurance carrier and the dentist, therefore, I am responsible for all dental fees. 
I understand that payment is- expected when services are rendered, unless other arrangements are made in advance, and that any payments received by the Dental Office from my insurance coverage will be refunded to me. 

We offer the following payment options:

Please make your choice, sign below and submit. 

WE RESERVE THE RIGHT TO CHARGE A FEE OF $150 FOR APPOINTMENT CANCELLED OR BROKEN 
WITHOUT 24 HOURS ADVANCE NOTICE. 

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