INFORMED CONSENT (please read completely)
I hereby authorize Doctor and his/her staff to perform all dental diagnostic procedures on my child including X-Rays, cleaning and topical fluoride treatment unless I have specifically made other arrangements in writing.
I understand that a plan of treatment will be presented BEFORE any treatment is performed and that I will have the opportunity to fully discuss with Doctor any alternatives to treatment including the use of any drugs, agents, or methods to be used. After accepting a mutually agreed upon treatment plan, as indicated by making an appointment for treatment, I CONSENT to the use of such methods and agents as may be indicated with such care. Agents may include, but are not limited to, local anesthetics commonly used in the practice of dentistry. Any drugs or sedative inhalants used wiII be discussed separately before using them unless they are used for life-saving purposes.