INSTRUCTIONS FOR ORAL/MODERATE SEDATION

 

1.     You must arrange to have someone to drive you to your appointment and sit with you in the office until the dentist is ready to treat you.  Someone must drive you home and assist you to your door after the procedure.  You should not go home by public transit or by taxi/Uber/LYFT unless accompanied.

2.     Do not wear facial makeup or nail polish.  Wear comfortable, casual and loose-fitting clothing.

3.     Contact us prior to the appointment if there has been a change in your general health (such as a severe cold, fever etc.).

4.     An estimate of your treatment will be given to you.  We will send a copy of your estimate to your insurance company.  Please be aware that payment in full is required the day of your treatment.  If you need to make a Financial Arrangement, please contact our Accounts Manager Debbie at least one week before your appointment.

5.     YOU MUST FAST FOR YOUR SEDATION APPOINTMENT:

8 hours after a meal that includes meat, fried or fatty foods;

6 hours after a light meal (such as toast, and a clear fluid) or after ingestion of nonhuman milk;

4 hours after ingestion of breast milk;

2 hours after clear fluids (such as water, fruit juices without pulp, carbonated beverages. NO tea NO coffee NO alcohol).

6.     ***IMPORTANT*** PLEASE ENSURE THAT YOU HAVE YOUR SEDATION MEDICATION WITH YOU AT THE TIME OF THE APPOINTMENT.  TO BE TAKEN ORALLY IN THE PESENCE OF THE DENTIST IN THE TREATMENT ROOM.  PLEASE REFER TO ACCOMPANYING DOCUMENTATION FOR DRUG INFORMATION.

1.  You must not drive a car or operate any heavy machinery for at least eighteen hours. You may be drowsy for the remainder of the day and should be recovering at home in the care of a responsible adult until you are fully alert.

2.  Do not travel by public transit or by taxi/Uber/LYFT.

3.  Do not drink any alcoholic beverages for at least eighteen hours.

4.  If there are any questions, do not hesitate to call our office at 613-230-7475.

A deposit of $600.00 is required to reserve your Oral Sedation Appointment. The $600.00 will be applied towards your treatment fee.

If you need to change or cancel your Oral Sedation Appointment, we require at least one week's notice in order to free up your reservation for another patient. Inadequate notice or failure to show for your appointment will result in the $400.00 deposit being processed as an insufficient notice penalty fee.

I fully understand and accept that there are inherent risks associated with sedation as explained to me by Dr. Bao Nguyen. Different options of sedation treatments were given to me and I choose to receive my dental treatment under Oral/Moderate sedation under the guidelines of the RCDSO. The sedation process was explained in detail to me. Pre-op and post-op instructions of this form were clearly reviewed. I have read and understood this form.