“I understand Dr. McCaffrey has my best interest in mind and at this time I am accepting upgraded material(s) at Dr. McCaffrey’s recommendation to better treat my conditions present, or because of personal preference. I do understand my acceptance to upgrade the material(s) used, above and beyond what is covered or considered by my Dental Insurance Company or as described in the current dental terminology edition presented by the American Dental Association, can generate additional expenses over the contracted dental network fees.I acknowledge that I have read and understand all the information provided to me regarding Financial Insurance Upgrade and Work Guarantee and that I have received a copy of this form.”