1- I authorize the staff of Niagara park Dental to take radiographs, photographs, study models, or any diagnostic aid required. All the records including my photographic records taken in the surgery are the property of Niagara park dental as long as they don’t reveal my identity. Niagara Park Dental staff have the right to use them in the way they see adequate. Niagara park Dental has the copy right to these records.
2- I authorize the dentist to carry out the required treatment as agreed by myself, and to use any assistance required to carry out the treatment.
3- I consent to the use of anesthesia, and any other medication as needed. I understand that using anesthesia involves some risks, I understand I can ask for any possible complications.
4- If my treatment is not finished on the day, or I need extensive treatment, I will be given a treatment plan showing expected fees. The plan is not a quote, but includes an estimate of fees.
5- The treatment plan consists of one or more visits. Payment for each visit is due immediately after the completion of the visit as deemed so by the dentist.
6- Any unpaid fees for a completed visit will go towards the outstanding balance.
7- The treatment is considered completed once all the steps in the plan have been finished as deemed so by the dentist, or failure to make or attend an appointment for 3 weeks. It is the patient’s responsibility to arrange an appointment by calling the surgery or coming in person. Should there be a dispute regarding offering an appointment, the patient needs to provide proof of his claims, Niagara Park Dental is not obliged to provide proof of offering an appointment.
8- Failure to pay any outstanding balance once the plan has been completed means there will be a $160 admin fees.
9- If there is any outstanding balance once the treatment has been completed, Niagara Park Dental may choose to follow the matter with the debt collector or any legal channel it sees adequate without any prior notification.
10- If Niagara Park Dental decides to follow any legal matter – whether to collect outstanding balance, or any other issue – The patient is responsible for all the legal fees incurred.
11- The patient, or other person responsible for the fee payment, agrees to indemnify Niagara Park Dental against any and all debt collection costs it incurs in recovering an unpaid and overdue account. I agree to these terms and conditions, and agree to any signed treatment plan I have been given by Niagara Park Dental.