Regarding the prosthetic for this patient, please acknowledge that ROE Dental Laboratory has informed you that the design of this case is not adequate to meet our warranty parameters. This case exhibits a design that lends to a high percentage of failure and that ROE Dental Laboratory offers no warranty. We are happy to move forward with this understanding or discuss design changes needed to avoid this consent authorization.

You further acknowledge that should this restoration fail for any reason that you will not hold ROE Dental Laboratory responsible for the time, materials or workmanship necessary to repair or replace the prosthesis, and understand that any request to do so will be charged at our standard laboratory fee.

By signing below or replying with your name and address in the body of the email, you understand that you are voiding the warranty on this product, and that consent is given to fabricate the prosthesis.