Southern Roots Dentistry General Consent
I understand that there are inherent risks involved in any type of invasive dental procedure such as injections (i.e prolonged numbness) and tooth preparation (i.e nerve damage). I give my consent for Dr. Lowder, Dr. Moore, Dr. Gilley, and their staff to perform the dental work that we mutually agree upon, fully understanding the risk involved.
I have read and understand the above information. To the best of my knowledge, the questions on the patient registration and medical history have been accurately answered. I understand that providing incorrect information can be dangerous to my (or patient’s) health. It is my responsibility to inform the dental office of any changes in medical status.