I, the undersigned, understand that as a patient I have the right to be informed about the diagnosis, the recommended treatments and associated risks / complications in order to best make an informed decision regarding my care. I authorize Dr. Launey and/or Dr. Launey’s qualified office staff member to use all diagnostic aids deemed appropriate to make a thorough diagnosis of my dental needs. I also authorize Dr. Launey and/or his qualified staff member to perform the treatment, medication and therapy that may be indicated to establish my optimum dental health. I understand that certain risks are associated with any dental treatment, and that the use of anesthetic agents (whether local anesthesia or nitrous oxide analgesia) embodies a degree of risk.
I acknowledge that I am responsible for the costs of my dental treatment. I understand that Dr. Launey’s office will file my insurance as a courtesy, and that I am responsible for any unpaid balance after my insurance benefits have been applied. I give my authorization to be contacted by a phone landline, pre-recorded/artificial voice message and/or an automatic dialing device or wireless means such as a cell phone or email in connection with any communications regarding my account. I agree to pay all charges and any additional costs (court cost, attorney fees, late fees, interest and/or collections costs) if any are associated with an unpaid balance.
I understand that it is Dr. Launey’s office policy that I must give 24 hours advance notice for missing an appointment, and that failing to give such notice could result in a missed appointment fee.
You have presented to the office today because you have a dental condition which cannot be postponed until the current COVID-19 risk period abates. Please be advised of the following:
A PPE fee will be charged each visit to offset the enhanced protective measures we are taking to keep you safe during the COVID-19 pandemic.
Your information will be encrypted.
Dr. Launey has practiced family dentistry since his graduation from Louisiana State University School of Dentistry in 1994. In 2015 Dr. Launey moved his Gretna practice to a newly updated and modern facility. Dr. Launey provides quality dental care tailored to the wants and needs of his patients. He remains committed to providing exceptional dental treatment to his patients and has incorporated many of the most up-to-date technologies in the dental field.
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