Esthetic Insert ApprovalForm

Patient Approval For Cementation

I have had the opportunity to view the color and shape of my dental esthetic work (crowns, veneers, bridges and/or implant crowns). I approve the restorations to be bonded in place. I understand that certain bite adjustments will likely need to be made after bonding in the teeth, but that other changes (e.g., relating to the color and shape) after the bonding process would likely require cutting off the restorations, which may result in further reduction in tooth structure and a full fee for the replacement.

By signing this Patient Consent Form, I am confirming that I have read this Consent Form prior to signature and I understand its contents. I consent to and authorise my Dentist to proceed with the cementation and am happy with the appearance of this case.