Informed Consent For Dental Treatment
I understand that I have come to the office of Frank C. Greider, M.S., D.D.S., P.C. for routine dental treatment and I do hereby give my consent for this treatment. I have been advised that though good results are expected, the possibility and nature of complications cannot be accurately anticipated and that, therefore, there can be no guarantee as expressed or implied either as to the results or as to cure. Fees are guaranteed for 12 months from the date of this statement.
I hereby state that I have read and understood this consent, and that all questions about the procedures have been answered in a satisfactory manner.
Please advise us in the future of any change in your medical history or any medications you may be taking.
List current medications, supplements, and or vitamins.
Ask for an additional sheet if you are taking more than 12 medications
We reserve the right to charge for appointments cancelled or broken without 24 hours advance notice
Please refer to our 24 hour answering service for after hours communications.
Please tell us about your Preferences
Dr. Greider and his staff can better recommend the most suitable preventive and corrective dental treatment for you with your completion of the questionnaire below. Is it important that they understand your individual needs, desires and personal values to best understand what you want for yourself. Please help us personalize your dental care so to meet your expectations by indicating your choices or opinions below.
Please mark off the statement that most represents YOU: