General Consent for Treatment

This is an informed consent that has been prepared to allow Dr. Walsh or other treating dentists or dental provider to examine, diagnose, and treat you, the Patient. The procedures covered by this informed consent include administration of local anesthetic, restorative preventative, cosmetic, diagnostic, and other dental procedures. This informed consent will remain in effect until treatment is terminated either by the Treating Dentist and/or the Patient and the Patient is no longer regarded as a patient of record.

I understand that dental treatment comes with corresponding risks and benefits, which have been disclosed and explained to me and I hereby consent to treatment.

I have been given the opportunity to ask questions relevant to my treatment. If I have any further questions, I will discuss them with my Treating Dentist.

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.