I authorize McCall Dental Centre and designated team members to take x-rays, impressions, scanning, photographs and other diagnostic aids deemed appropriate to diagnose my case thoroughly.
I understand that my general dentist's role is to provide an examination, clarify the findings, and offer treatment options with consequences. I understand that McCall Dental Centre and designated team members will support my decision, provided I am fully informed. I understand that I can request treatment from a specialist anytime (albertadentalspecialists.ca).
Upon such diagnosis, I authorize McCall Dental Centre and its team to perform all recommended treatment requested by me and to employ such professional assistance as is required to provide proper care.
I agree with the use of anesthetics, sedatives and other medication as necessary. I fully understand that using anesthetic agents embodies a certain risk. I know I can ask for a complete recital of any possible complications.
I authorize releasing examination findings, diagnosis, treatment program, and ongoing progress reports to any referring dentist, physician, chiropractor, or other health care professionals as indicated.
I also authorize the release of any medical information to insurance companies for legal documentation to process claims. I consent to my photos, videos, and x-rays before and after being used for scientific purposes in publications and presentations, social media posts, the company's website gallery, and a compilation book.
I understand that my identity will be protected, and these media forms will not be used for other commercial purposes without my consent.
FINANCIAL POLICY
Payment is expected on the day of your procedure, as outlined verbally and in the written financial arrangement. We accept cash, cheque, Mastercard/Visa, and E-transfer. For our patients carrying dental insurance, we are happy to assist you with your insurance billing as a courtesy. However, your financial responsibility lies with you, including checking your full dental coverage with your insurance.
I understand that payment is due at the time of service, and I agree to be responsible for payment of all services rendered on my behalf or my dependents. If payments are not received as agreed, I understand that my account may be turned over for legal collection of any overdue amount. We aim to eliminate "billing surprises," so let us help you plan your treatment carefully by addressing your financial concerns before treatment begins.
APPOINTMENTS POLICY
Should you need to cancel an appointment, please notify our office at least two working days in advance. If you fail to cancel your appointment appropriately or do not show up for your scheduled appointment, you may be charged a broken appointment fee of $100.