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Notice of Informed Consent
I have been given the opportunity to ask any questions regarding the nature and purpose of recommended treatment and have received answers to my satisfaction. I voluntarily assume any and all possible risks including, but not limited to risk of substantial harm, if any, which may be associated with any phase of this treatment in hopes of obtaining the desired potential results, which may or may not be achieved. No promises or guarantees have been made to me concerning the results. The fee(s) for this service have been explained to me and are satisfactory. By signing this document, I freely give my consent to allow and authorize the dentist and/or his/her associates or agents to render any treatment necessary and/or advisable to my dental conditions, including the administration and/or prescribing of any medications.