Final Cementation Consent
The nature and type of material used in my crowns, bridges and/or veneers has beenexplained to me. By signing below, I acknowledge and authorize the materialdiscussed to be used in my mouth. I have been given the opportunity to view mycrowns, bridges and/or veneers as processed, either on models or placed in mymouth prior to final cementation.I approve the color, shape, feel and overall appearance of the porcelain. Iunderstand that once the porcelain is cemented in my mouth, the factors of color,shape, feel and overall appearance cannot be changed without additional andpossibly significant time being taken and fees assessed. I further understand thatremoving cemented porcelain may create the risk of injury or breakage to theunderlying teeth and will destroy the porcelain, requiring a remake. I furtherunderstand that if I authorize cementation and later decide I do not like therestorations, any replacement(s) of the cemented restorations will be at full cost.By signing this Consent for Final Cementation I give the office named above myconsent for final cementation, acknowledge my approval of the appearance andauthorize use of the discussed material.
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Signed by The Loving Dentist After Hours Care
Signed On: April 4, 2018
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Document Name: Final Cementation Consent
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