6 Month Update Form
As a child is a minor, it is necessary to obtain permission from a parent or guardian before today's treatment. If you are 18+ years of age, you can complete your own forms. The signature of a parent or guardian or patient 18+ years of age affixed below authorizes the completion of all agreed upon dental treatment. This consent shall remain in full force and in effect until cancelled by either party. Furthermore, the undersigned agrees to be responsible for any bill incurred by this patient for dental treatment regardless of insurance coverage. I understand fulyl this consent and have no further questions.