Consultation Consent Test

  • I,
  • understand that I am receiving a complimentary consultation, and if needed, a 3D CBCT Scan (Cone Beam CT Scan). This consultation is solely to see if I am a candidate for dental implants. The CT Scan is at no charge unless I request a copy. There will be a copy fee of $350. I understand that this consultation is not intended to treat or diagnose any existing medical or dental disease/illness. I understand that this consultation is being recorded (video and audio) and is monitored by office personnel. By signing below, I agree to the mentioned above.
  • Date Format: MM slash DD slash YYYY