CONSENT FOR TELEDENTAL CONSULTATION & SMILE ASSESSMENT
I agree to engage in a TeleDental Consultation & Smile Assessment with the following understandings:
- I understand that the video conferencing technology that will be used to affect such a consultation will not be the same as a direct client/doctor visit due to the fact that I will not be in the same room with the doctor.
- I understand that while a TeleDental Consultation & Smile Assessment has many potential benefits including easier access to care and the convenience of meeting from a location of my choosing, it is NOT an Emergency Service and in the event of an emergency, I will use a phone to call 000.
- I understand there are potential risks to this technology, including interruptions, unauthorized access, and technical difficulties.
- I understand that the doctor or I can discontinue the TeleDental Consultation & Smile Assessment session if it is felt that the videoconferencing connections are not adequate for the situation.
- I understand I will have a direct conversation with the doctor, during which I will have the opportunity to ask questions in regard to my dental concerns and/or the treatments I am pursuing. Risks, benefits and any practical alternatives will be also be discussed.
- To maintain confidentiality, I will not share my TeleDental Consultation & Smile Assessment appointment link with anyone unauthorized to attend the appointment.
- I understand that any surgical or invasive procedure carries risk. I also understand that before proceeding with a treatment recommendation that may require surgery (e.g. dental implants), it is recommended that I seek a second opinion from an appropriately qualified health practitioner.
BY CLICKING ON THE CHECKBOX BELOW I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.