I, the undersigned, acknowledge that I have provided an accurate personal and medical-dental history and to the best of my knowledge, al the preceding answers are true and correct. I wil inform you if there are any changes ni this person's health or medications at future appointments.
You may contact their physician, fi necessary, to discuss any relevant medical information.
I consent to the performing of any dental procedures and x-rays agreed to be necessary or advisable and I will ascsuhmanegeanayn responsibility for fees associated with such procedures. I understand that 48 hours notice must be given fi I need to appointment, otherwise a fee may be charged.