Dental Radiographs (X-Rays) are necessary to monitor oral health, diagnose, and treatment plan accurately.

I understand dentistry is not an exact science and there is no guarantee of specific results.  For the best results, it is imperative that I work together with the dental care team.  This means that I will cooperate and participate in the radiographic guidelines set by the American Dental Association and my dental care team for my individualized oral and systemic health care.

I understand the dental care team will recommend necessary radiographs annually and in other specific situations as needed.  The dental team will do their best to make sure I understand their care and plan.  If I do not understand any of the treatment or the plan, I will discuss it with the dental team. 

I understand if I do not fulfill my part of the agreement by following their advice, I will be limiting my doctor’s ability to diagnose and treatment plan accurately. I accept the risk that problems that can only be seen on dental radiographs will be missed in their diagnosis and treatment planning.  I understand that if I refuse to have radiographs taken, then some treatments cannot be completed at all. I understand if I refuse radiographs, a “Refusal of Diagnostic Radiographs” form will be presented to sign and added to my chart. This form will expire at the recommended radiographic guideline, and if radiographs are still refused at that time, then it may warrant a dismissal from the practice. 

I understand that should I feel there are changes in my condition or symptoms that appear between scheduled visits, I should notify the office immediately.