I hereby authorize the doctor or any / any assistant or employees selected by the doctor to treat the condition described as above:Notes: Type a label
1. I further consent to such dental care, diagnostic procedures, and dental treatment that the dental staff may deem necessary or advisable.
2. I have been informed of:
a.) The nature of the proposed operation, procedure and/or treatment.
b.) The alternatives – including no operation, procedure and/or treatment.
c.) The risk of the possibilities of complications from, and the consequences of the proposed operation, procedure, and/or treatment all sufficient detail to permit me to make reasonable decision in this consent.
3. I am aware that, in the practice of dentistry, other unexpected risks or complications may occur. I further acknowledge that no guarantee or assurance has made to the results that may be obtained.
4. I authorize preservation of any specimens taken for laboratory pathological examination for the diagnostic and treatment purposes, or the disposal of such specimens according to the rules and regulations of Dubai Health Authority.
5. I authorize the use of dental/medical information obtained about me and the disclosure of such information to my treating dentist.
6. I agree to be responsible for the full payment of all charges for the services performed on me.
7. I also acknowledge that this consent is subject to the laws and jurisdiction of UAE.
8. Comments: