I hereby certify that the stainless-steel crowns have been presented to me and its indications have been explained thoroughly. I fully certify that I understand the usage and indications of the stainless-steel crows including the fact that they may not be esthetically pleasant. I therefore authorize Dr. Claudia Rodriguez DDS, Sunshine Pediatric Dentistry to perform the placement of stainless-steel crown/crowns on my son/daughter.