Treatment Consent - Terms

1. I freely consult with the dental practitioner and have provided as accurate and complete medical and personal history as possible including antibiotics, drugs, or other medications I am currently taking as well as those to which I am allergic to.

2. I understand that no dental treatment is completely risk free and that my dentist will take reasonable steps to limit any complications of my treatment. I understand that some after-treatment effects and complications tend to occur with regularity.

3. I have been given ample opportunity of asking questions about the proposed treatment, alternative treatments, if any, and risks and have them fully answered. I understand the nature of the recommended treatment, alternate treatment options, and the risks of the recommended treatment.

4. I realise that in spite of the possible complications and risks, my recommended treatment is necessary. I am aware that the practice of dentistry is not an exact science, and I acknowledge that no guarantees, warrantees, or representations have been made to me concerning the results of the procedure.

5. I will follow any and all treatment and post-treatment instructions as explained and directed to me and will permit the recommended diagnostic procedures, including X-rays.

6. The full the cost of the treatment or operation has been explained to me and undertake to settle the account in full on completion of the treatment or operation.

7. I accept that unforeseen conditions may arise during the course of the treatment or operation that may require additional or different procedures than those indicated to me. I authorise and request the above named dentist to remedy such conditions as may be necessary in his or her professional judgement.

8. My co-operation is crucial in order to ensure that schedule appointments are adhered to and to maximise the success of the treatment and the protection of my or my child's /children's oral health.

9. I hereby consent to the use of the records pertaining to me or my child's treatment or operation, including photographs and x-rays taken in the process of examinations and treatment, for the purposes of professional consultations, research, education or publication in professional journals or to supply them to my medical scheme or funder. I understand that my identity or that of my child will at all times remain strictly confidential.

10. I agree and wish to proceed with recommended treatment.

11. I understand that if any unexpected difficulties occur during treatment, I may be referred to a dental specialist.

12. I understand all the information that has been provided, and I hereby consent and authorise Dr. D. Naidoo (The Dental People) to continue with the dental treatment prescribed to me.