Purpose of Consent
The purpose of this form is to provide information to the patient regarding the nature of the dental consultation and evaluation process, and to obtain consent for the examination, diagnostic procedures, and any necessary imaging or tests.
Description of the Consultation Process
- Clinical Examination:
A thorough examination of your teeth, gums, and oral structures will be conducted. - Diagnostic Procedures:
This may include X-rays, photographs, or other diagnostic tools to evaluate your dental condition accurately. - Discussion of Findings:
The dentist will review the results of the examination and any diagnostic tests, discuss findings, and recommend treatment options if necessary. - Potential Risks:
- Temporary discomfort during examination.
- Exposure to minimal radiation if X-rays are required.
- Unforeseen findings may require additional testing or specialist referral.
- Benefits:
- Accurate diagnosis of dental issues.
- Development of a personalized treatment plan.
Patient Acknowledgment
By signing this consent form:
- I confirm that I understand the purpose, process, and potential risks of the dental consultation and evaluation.
- I agree to undergo the recommended examination, imaging, and diagnostic procedures.
- I understand that I can ask questions and discuss concerns with the dentist at any time before or during the process.
- I understand that this form does not constitute consent for any treatment other than the consultation and evaluation. Separate consent will be required for treatment.
Patient Rights
I understand that I have the right to:
- Decline the consultation or diagnostic procedures at any time.
- Request additional information about the procedures.
- Seek a second opinion before proceeding with any recommended treatments.
Refund Policy for Platinum Dental Surgery Registered Clients
At Platinum Dental Surgery, we value our registered clients and aim to provide transparency and exceptional service. We understand that circumstances may arise that require a refund. Please review our refund policy outlined below, which applies specifically to our registered Platinum Dental Surgery clients, in order to gain a thorough understanding of the process:
Eligibility:
- The refund policy is exclusively applicable to clients who have completed the registration process and meet all necessary requirements as specified by Platinum Dental Surgery.
- Refund Percentage:
- For procedures that have not been initiated, registered clients are entitled to a refund of 75% of the total fees paid for the respective dental procedure, treatment, or service.
- For procedures that have been initiated, registered clients are entitled to a refund of 25% of the total fees paid for the respective dental procedure, treatment, or service.
- The refund percentage is calculated based on the total amount paid for a specific dental procedure being executed and is non-negotiable.
Refund Request and Timeframe:
- To initiate a refund, registered clients must contact Platinum Dental Surgery’s clinic head within 24 hours of the intended procedure that hasn’t been initiated.
- Refund requests received within this timeframe will be considered for the applicable refund percentage, as mentioned in point 2.
- It is crucial to notify Platinum Dental Surgery promptly to allow for proper processing of the refund request.
Refund Process:
- Registered clients should reach out to Platinum Dental Surgery’s customer service department directly to initiate the refund request.
- During the refund process, clients will be required to submit all relevant documentation, including proof of payment, registration details, and any necessary receipts.
- Platinum Dental Surgery will carefully review the documentation provided and verify the eligibility for a refund.
- Upon successful verification, Platinum Dental Surgery will process the refund within 10 working days.
Exclusions:
- This refund policy is exclusively applicable to only registered clients of Platinum Dental Surgery and does not extend to non-registered clients.
- The refund policy does not cover any additional expenses incurred by the client, such as travel costs, accommodation, or any other related expenses.
Refund Method:
- Refunds will be issued via bank transfer to the same account.
Modifications to the Refund Policy:
- Platinum Dental Surgery reserves the right to modify or update the refund policy specifically for registered clients at any time without prior notice.
- We hope that this detailed explanation of our refund policy for registered clients clarifies the process and provides you with a comprehensive understanding. Should you have any further inquiries or require clarification, please do not hesitate to contact our consultant (08033738471) or email [email protected].
- I have read and understood the refund policy provided by Platinum Dental Surgery for registered clients. By appending my signature below, I acknowledge that I have reviewed the policy, and I agree to abide by its terms and conditions.
