CROWN CONSENT FORM

By signing below, I acknowledge and authorize the material discussed to be used in my mouth. I have been given the opportunity to view my crowns, bridges and/or veneers as processed either on models or placed in my mouth prior to final cementation.


I approve the color, shape, feel and overall appearance of the porcelain. I understand that once the porcelain is cemented in my mouth, the factors of color/shape/feel and overall appearance cannot be changed without additional and possibly significant time being taken and fees assessed. I further understand that removing cemented porcelain may create the risk of injury or breakage to the underlying teeth and will destroy the porcelain, requiring a remake. I further understand that if I authorize cementation and later decide I do not like the restorations, any replacement(s) of the cemented restoration(s) will be at full cost.


By signing this Consent for Final Cementation, I give Kasey Davis Dentistry my consent for final cementation, acknowledge my approval of the appearance and authorize use of the discussed material.