Consent to Treatment

Consent

I authorize Dr. Garima Talwar, Dr. Hemani Kaur, Dr. Nishal Patel and the clinical team at Esthetique Dentistry of Ashburn to perform the dental examinations, diagnostic imaging, cleanings, and treatment they determine to be necessary or advisable for my care.

Information and questions

I understand that the recommended treatment, reasonable alternatives, and material risks will be explained to me before treatment begins, and that I may ask questions at any time.

I understand that dentistry is not an exact science and that no guarantee has been made to me about the result of any treatment.

My right to decline

I may decline any procedure at any time, including after treatment has been recommended or scheduled. Declining a recommended treatment will not affect my ability to receive other care at this practice, although it may affect the outcome of my care, and the practice will explain those consequences to me.

Accuracy of the information I have given

I certify that the health and insurance information I have provided is accurate and complete to the best of my knowledge, and I will tell the practice if it changes — in particular any change to my medications, allergies, or medical conditions.

Separate consent for specific procedures

Certain procedures — for example extractions, implants, root canal treatment, and sedation — carry their own risks and are covered by a separate consent form that will be discussed and signed before that treatment. This general consent does not replace those.