I understand that during treatment it may be necessary to change or to add procedures because of conditions found while working on the teeth that were not discovered during examination, the most common being root canal therapy following restorative procedures.

I give my permission to the dentist to make any/all changes and additions necessary.
In relation to specific modalities of my child’s treatment the following has been discussed with me:

YOUR SIGNATURE ON THIS FORM INDICATES THAT YOU UNDERSTAND THE NATURE OF THE PROPOSED TREATMENT, THE RISKS AND ALTERNATIVES TO SUCH TREATMENT AND THE CONSEQUENCES OF NOT UNDERGOING TREATMENT. YOU ALSO INDICATE THAT ALL YOUR QUESTIONS HAVE BEEN ANSWERED TO YOUR SATIFICATION AND THAT YOU BELIEVE IT TO BE IN YOUR CHILD’S BEST INTEREST TO PROCEED WITH PROPOSED TREATMENT. PLEASE NOTE IT IS NOT POSSIBLE TO PREDICT OR GUARANTEE THE OUTCOME OF ANY TREATMENT(s). PROPOSED TREATMENT MAY ACTUALLY CHANGE DUE TO THE PATIENTS ACTUAL DENTAL CONDITION AT THE TIME OF TREATMENT.