I agree to what is proposed - which has been explained to me by the dentist named on this form - and to the use of the type of anaesthetic that I have been told about.
I understand that any procedure, in addition to the investigation or treatment described on this form, will only be carried out if it is necessary and in my best interests and can be justified for medical reasons.
I have told the dentist about any additional procedures I would wish not to be carried out straightaway without my having the opportunity to consider them first.
DO NOT SIGN THIS FORM UNLESS YOU HAVE READ AND UNDERSTAND ALL THE INFORMATION.