The dental treatment necessary to my existing oral condition(s) has been explained to me and my questions have been answered satisfactorily. I hereby authorize Doctor James R. Healy. D.D.S. and/or such associates or assistants as he may designate to perform those procedures, including surgery. as may be deemed necessary or advisable to my dental treatment including arrangement and/ or administration or any anesthetic sedative analgesic, therapeutic and/or other pharmaceutical agent(s), including those related to restorative, palliative, surgical, anesthetic sedative analgesic, medicinal or drug treatment(s) and do voluntarily assume the possible risks with these procedures