Consent Terms

The undersigned hereby authorizes Dr. John Hucklebridge to take X-rays, study models, photographs, or any other diagnostic aids deemed appropriate by Dr. John Hucklebridge to make a thorough diagnosis of the patient’s dental needs. I also authorize Dr. John Hucklebridge to perform any and all forms of treatment, medication and therapy, that may be indicated in connection with you the patient and further authorize and consent that Dr. John Hucklebridge choose and employ such assistance as he deems fit. I also understand that use of anesthetic agents embodies a certain risk. I understand that responsibility for payment for Dental Services provided in this office for myself or my dependents is mine, due and payable at the time of services are rendered unless financial arrangements have been made.