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Name: AGD# Address:_______________________________________________________________________________________ _______________________________________________________________________________________ Office Phone:___________________________ Office Fax: _______________________________________________ E-mail Address__________________________________________________________________________________ AGD Members - $695.00 Non-Members - $795.00 (Limited to 40 Participants) Card Number: CVC# Exp. Date:_________________________ Amount:______________________________________________________ Signature:______________________________________________________________________________________ Mastercard Visa Check Enclosed April 13–14, 2012 Embassy Suites - Airport 7901 34th Ave S. Bloomington, MN Mail or Fax is Form to MN AGD at 770 Mount Curve Blvd. St. Paul, MN 55116 For Information Call: 612.412.4366 Fax: 1.877.839.2839 Treating Anxious and Special - Needs Patients ( Use one form per person - Please make copies) Location and Time Embassy Suites - Airport 7901 34th Avenue South Bloomington, MN 55425 ( 952 ) 854-1000 8:00am Registration (Friday) 8:30am - 4:30pm Course Friday evening dinner included Fee $695.00 AGD Member $795.00 Non-Member (Limited to 40 Participants) Credits 14 participation credits (12 Special Patient Care, 2 Oral Surgery) An additional 18 participation credits in special patient care, oral surgery, pharmacology, and/or pediatric dentistry can be earned by completing the clinical homework assignment and presenting it in October. HARVEY LEVY, DMD, MAGD, LLSR Dr. Harvey Levy is a general and hospital dentist from Frederick, Maryland, where he offers full service dental care emphasizing treatment for individuals with anxiety or special needs. He serves as department head at Frederick Memorial Hospital where he provides comprehensive dental care in the OR. During his 38 year career, Dr. Levy has treated 1,400 hospital patients and administered oral sedation during 30,000 patient office visits. He is ACLS certified, holds a Class I sedation permit, and has been a BCLS instructor-trainer for the American Heart Association. Dr. Levy has earned a Mastership and two Lifelong Learning Service Recognitions by the Academy of General Dentistry along with eight fellowships, four diplomate certificates, and board certification in Integrative Medicine. He completed a two-year residency in Rochester, NY, and was a GPR residency clinical director at the Univ. of Penn. Hospital. Dr. Levy has wrien many articles, produced on-line courses, audio and video tapes, and lectured to thousands. His work with anxious and special-needs patients has earned him the AGD Humanitarian Award, the ADA Access to Care Award, the Maryland Governor’s Doctor of the Year Award, and the honor of being a 2002 Winter Olympic torch runner. Topics 1. Physically and Mentally Challenged Patients 2. Geriatric Patients 3. Medically Compromised Patients 4. Chemotherapy and Radiation erapy Cancer Patients 5. Pharmacology for office sedation 6. Ergonomic Exodontia Treating Anxious and Special-Needs Patients April 13-14, 2012 A Master/Fellow Track Continuum Advancing Professional Excellence in Dentistry
