Terms of Acceptance
1. All dental treatment is carried out using the latest techniques, equipment and materials. All equipment is either disposable or sterilised using an autoclave which is validated daily for optimal efficiency.
2. It is the policy of this practice to take diagnostic radiographs (x-rays) at the first examination and specific radiographs (x-rays) as required before certain procedures.
3. Any treatment required will be provided with the patient’s informed consent after all risks associated with the treatment are outlined.
4. All information on this form is considered confidential and is necessary to ensure that the best possible treatment can be provided.
5. Each appointment made is a contract between North Shore Dentistry and the patient. All appointments cancelled with less than 24 hours notice will incur a $100 cancellation fee to help cover costs.
6. An estimate of fees for treatment should be outlined prior to treatment being provided. If you are not sure of estimated fees, please let our Practice Manager or your Dentist know.
7. All fees incurred per appointment must be settled at the completion of that appointment, unless a payment plan has been created with your Dentist or the Practice Manager.
8. Dishonoured cheques will incur a $50.00 dishonour fee.
9. Should any account for any reason become outstanding, then the patient, or person responsible for accounts, will be responsible for all debt collection charges incurred.
10. Should any photographs be taken of you, please confirm if you are happy for these to be used for: