Mahnaz Gorgani, D.M.D. Aneesha Amarnath, D.M.D.
Our dental office philosophy is based on our commitment to preventive dentistry and to creating a supportive, nurturing environment for the children and young adults under our dental care. in particular, we are dedicated to providing safe,comfortable and quality dental treatment for all of our patients.
California State Law requires us to obtain your informed consent before we can provide any dental services for your child. Our most important general office policy is to “inform before we perform”. We are requesting your permission for the following diagnostic and preventive dental procedures: comprehensive clinical examination, selected diagnostic x-rays, thorough professional cleaning and topical fluoride treatment.
If dental treatment is necessary, we require your consent for a number of additional procedures which include, but are not limited to, the following: Local anesthesia (“novocaine” or “lidocaine”), nitrous oxide-oxygen sedation (laughing gas), comfortable mouth prop (“tooth pillow”) and extensive use of classic “tell-show-do” method of introducing new methods and materials to your child.
We will verbally inform you before dental treatment is performed on your childf. Please feel free to ask us any questions you may have regarding the preceding information or concerning any other aspect of our dental practice. Additionally, you may wish to discuss our policies with other individuals who are involved in caring for your child.
I, hereby, give my consent to Mahnaz Gorgani, DMD and/or Natalie Vander Kam, DDS to provide mutually agreed upon dental services for my child. I further agree that this consent shall remain in force unless withdrawn in writing by the person who has signed below on behalf of the minor patient or themselves.