Online Patient Form

1. I hereby authorise the dentist or designated staff to take X-rays, study models, photographs and other diagnostic aids deemed appropriate by the dentist to make a through diagnosis.

2. Upon such diagnosis, I authorise the dentist to perform all recommended treatment mutually agreed upon by me and to employ such assistance as required to provide proper care.

3. I agree to the use of anaesthetics, sedatives and other medication as necessary. I fully understand that using anaesthetics agents embodies certain risks. I understand, I can ask for a complete recital of any possible complications.

4. I agree to be responsible for payment of all services rendere on my behalf and on behalf my dependents. I understand that payment is due at the time of service unless other arrangements have been made.