I authorize Dr. Alan Baughman DMD of Clearwater Dentistry, and/or such persons as he may appointment, to provide treatment, to perform or assist in the performance of dental treatment or procedures at Clearwater Dentistry. I consent to the administration of any anesthetic that Dr. Alan Baughman or her appointees deem necessary to provide the proper treatment and to help my dental treatment be as comfortable as possible. I understand that the potential complications from routine treatment include, but are not limited to allergic reactions, drug reaction, pain, swelling, bruising, temporary or limited opening, temporary or permanent numbness, temporary or permanent mouth problems, and infection. I consent to have exams, radiographs, cleanings, photographs and other diagnostic aids/tests performed, as prescribed by the doctor or hygienist, at Clearwater Dentistry.
I understand that it is my responsibility to inform the dentist of changes in my medical history and medications prior to treatment. Occasionally, unforeseen conditions, new developments or findings, or changes in circumstances may arise during the course of treatment that may require additional treatment. I understand that any treatment plans presented, along with the associated fees, could change depending on the time elapsed since the most recent examination and extent of dental pathology. The team at Clearwater Dentistry will always discuss these changes in treatment and cost, and I will have the ability to ask questions.
