Date*

I, First name*   Surname*, designed and/or revised the implant-prosthetic treatment plan of the Patient   First name*   Surname* ,using the 3DIEMME RealGUIDE™ software or the Oxy Digital Solutions (ODS) Guide software, starting with CT/CBCT (.dcm file) and 3D scans (.stl, .obj, .ply, ... file) of the Patient.

I approve the treatment plan, defined independently or assisted by the ODS Technical Assistance team, for the modelling and possible 3D printing of surgical guide to be used to perform a guided implant surgery on the Patient.

I accept that Biomec Srl - Oxy Implant does not perform any clinical review of the project and therefore assumes no responsibility for temporary or permanent damage caused to the patient as a result of the surgical guide usage.

I therefore relieve Biomec Srl - Oxy Implant and ts employess, consultants or collaborators from any responsability for the surgery outcome.

I declare that I have the legal qualifications for the definition of the treatment plan, and I assume full responsibility for the design and use of the surgical guide and any prosthesis, realised from the approved project:

Project: [PROJECT TITLE]   Text*      

Last update: [PROJECT SAVE DATE AND TIME]   Date*   Time AM PM *