CONSENT FOR SERVICE
- I, the undersigned, consent to the performing of dental and oral surgery procedures agreed to be necessary or advisable, including the use of local anaesthetics as indicated and I will assume responsibility for the fees associated with those procedures.
- I understand that the practice requires as minimum 24 hours notice if I need to cancel my schedules appointment and that a cancellation fee of $50.00 could be incurred if I fail to do so.
- I hereby consent to use of any study models, x-rays, computer images and photographs at various dental seminars, lectures, and publications that the dentists may author.
- I am aware that payment is required on the day of the treatment