General Consent for Dental Treatment


    We are required to obtain your consent for contemplated or proposed dental treatment or oral surgery. Please read this form carefully and we encourage you to ask any questions you may have or if you need further explanation before. We will be happy to answer any and all questions. Before any treatment is rendered the Doctor will explain and ask permission before getting started.  
    1. I hereby authorize and direct The Dentists at Greenway, assisted by Licensed Dentists and/or Dental Auxiliaries of their choice to perform and assist upon me. The following dental treatment procedures (or oral surgery) including the necessary advisable local anesthesia, radiographs (x-rays) or diagnostic aids.  
    2. In general terms, the dental procedures may include one or a number of the following: a. Cleaning of teeth and application of topical fluoride  
    b. Application of sealants to the grooves of teeth.  
    c. Treatment of diseased or injured teeth with dental restorations. These restorations may either by amalgam (silver) or composite (white) material.  
    d. Stainless steel crowns for children. These are necessary in cases where simple fillings would not be the best long term restoration or in cases where there are large cavities.  
    e. The replacement of missing teeth with a dental prosthesis (crown, partials, etc)  
    f. Extraction (removal) of one or more teeth that cannot be saved.    
    g. Treatment of diseases or injured oral tissue (hard and/or soft).  
    h. Treatment of malaposed teeth.
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