I. Recommended Treatment
I hereby give consent to Dr. Alex Mercado to perform recommended treatment and any such additional procedure(s) as may be considered necessary for my well being based on findings made during the course of the recommended treatment. The nature and purpose of the Recommended Treatment have been explained to me and no guarantee has been made or implied as to the result or cure. I have been given satisfactory answers to all of my questions, and I wish to proceed with the Recommended Treatment. I also consent to the administration of local anesthesia during the performance of the Recommended Treatment.
II. Treatment Alternatives
Alternative methods of treatment have been thoroughly explained during my exam. All of the risks, benefits and options have been provided, but I wish to proceed with the recommended treatment described above.