MEDICAL HISTORY FORM

CONSENT FOR TREATMENT

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 thorough 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 anaesthetic 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 rendered on my behalf and on behalf of my dependents. I understand that payment is due at the time of service unless other arrangements have been made.

CANCELLATION POLICY
Appointments made at our practice are reserved exclusively for you and are considered confirmed at the time of booking. We strive to provide courtesy reminder calls or messages as a service to our patients, however in the event that you do not receive a call or message your appointment remains valid and confirmed. A fee will apply for failed attendances or cancellations of less than 24 hours notice.