Consent for Treatment
I hereby authorize the dentist or designated staff to take x-rays, study models, photographs and other diagnostic aids deemed appropriate to make a through diagnosis.
Upon such diagnosis, I authorize the dentist or designated staff to perform all recommended treatment mutually agreed upon by me and employ such assistance is required to provide proper care.
I agree to the use of anaesthetics, sedatives and other medications as necessary. I fully understand that using anaesthetic agents embodies certain risks. I can ask for complete recital of any possible complications.
I acknowledge that in case of any medical/ dental record enquiries, there will be an associated, non refundable, processing fee as per the current terrif.
I give consent to share my medical records when it has been deemed necessary to seek an external professional advice, opinion or for referral purposes.
I am the responsible person for payment of all services rendered on my behalf and on behalf of my dependents. I understand that payment is due at the time of service unless other arrangements have been made.
I acknowledge that a 24 hours notice is required to cancel or reschedule my dental booking. A short notice or absence without notice will arise a cancellation fee as per current tariff.