INFORMED CONSENT AGREEMENT

INFORMED CONSENT AGREEMENT

We are launching our Virtual Video Consultation as an assessment tool that we use to assess all forms of dental needs with an opportunity to answer all your dental questions from the comfort of your homes following the outbreak of the global pandemic.

Using your smartphone or any internet-enabled device, you can submit your form for assessment by our dedicated team. All images are automatically uploaded to our email and a dedicated file opened for each individual. Every information given is  treated with the utmost level of confidentiality.

For assessment of children 13 years and below, the full consent of parents or guardians must be given. All sensitive information such as personal data, email, age, phone number, pictures, and devices would be protected.

Having gone through the information provided for the virtual video consultation provided by Faces ‘n’ Braces Dental Clinic,

  • I understand the benefits, risks, inconveniences associated with the assessment, I have been sufficiently informed and acknowledge that Faces ‘n’ Braces Dental Clinic cannot make any guarantees or assurance concerning the outcome of my assessment and treatment recommendations.
  • I authorize my dentist to release my medical record and medical information in his/her possession: (i) to other licensed dentists/orthodontists and organizations employing licensed dentist/orthodontists, its representatives, employees, successors, assigns, and agents for the purposes of providing a more accurate assessment and/or treatment recommendation. I hereby consent to the disclosure(s) as set forth above. I will not, nor shall anyone on my behalf seek legal, equitable or monetary damages or remedies for such disclosure. I acknowledge that use of my Medical Records is without compensation and that I will not nor shall anyone on my behalf have any right of approval, claim of compensation, or seek or obtain legal, equitable or monetary damages or remedies arising out of any use such that comply with the terms of this Consent.