2. Upon such diagnosis, I authorize doctor to perform recommended treatment mutually agreed upon by me and to employ such assistance as needed to provide proper care.
3. I agree to allow the use of diagnostic adjuncts to communicate with other dental professionals to assist in my care and with insurance companies to allow benefits and for educational purposes and limited publication.
4. I fully understand that I agree to the use of local anesthetics, sedative and other medications as necessary and previously agreed to by me. I fully understand that using anesthetic agents embodies certain risks. I understand that I can ask for a recital of possible complications.
5. We are pleased to reserve time uniquely for you. We will not make another person’s appointment at your reserved time. Since a scheduled appointment is a commitment of time between you and our practice, if you find that you cannot keep your scheduled appointment, we ask you to provide a minimum of forty- eight business hours notice to us so we may schedule another patient in need of treatment. If you fail to attend at your reserved time, we may see you on a daily space available basis, rather than by reservation. As an alternative we may also accept a non refundable prepayment for your reservation of time.