Consent for Services
To the best of my knowledge, the preceding answers and all information provided are true and correct. Should I have any change in my health status or personal details, I will inform the doctor at my next appointment, without fail. I understand that notes, radiographs (x-rays) or models relating to my treatment may need to be sent to other practitioners to aid them in my treatment and consent to this. I understand that dental treatment must be paid in full at the time of treatment. I acknowledge that if an account is overdue The Smile Place Mt Eliza reserve the right to refer the account to a third party. I agree to meet all reasonable costs incurred by The Smile Place Mt Eliza in employing the said third party, to collect the overdue account.
I understand that if I do not give at least 24 hours’ notice a cancellation fee may be charged.