Applicability
This Agreement applies equally to HMO enrollees and private patients. Execution binds the patient, their guarantor, and/or their HMO.
Legal Basis: Constitution (1999, as amended) S.17(3)(d); Medical & Dental Practitioners Act Cap M8 LFN 2004.
Instructions & Execution
By completing this form and returning it from my personal email, I acknowledge that:
- My typed name and email constitute a valid electronic signature.
- Such signature has the same legal effect as a handwritten signature.
- I waive any objection to admissibility under authenticity or hearsay rules.
Legal Basis: Evidence Act 2011 S.93–94; Electronic Transactions Act 2015 S.17–18; Constitution S.39.
First Registration Caveat
The first registration platform serves as the binding foundation of all patient–clinic engagements.
It authorizes consent for all forms of dental procedures, incorporates all subsequent consents, and confirms that the wet-ink signature obtained at the Clinic shall be scanned, digitized, and uploaded to all relevant clinical and administrative records, and shall be deemed original and enforceable.
Legal Basis: Constitution S.17(3)(c); Medical & Dental Practitioners Act; Evidence Act 2011 S.93.
Clause 1 – Consent Confirmation
I confirm I have been adequately counseled on the proposed procedure(s), including risks, limitations, and alternatives. Consent, once executed, is final and enforceable.
Legal Basis: Constitution S.39; MDCN Code of Ethics (2004) Rule 29.
Clause 1A – Procedural Scope & Associated Treatments
- I authorize Platinum Dental Surgery to carry out the specific procedure(s) listed below and any adjunct, supportive, or incidental procedures reasonably required to complete, stabilize, or maintain the intended outcome.
- This authorization extends to diagnostic imaging, anaesthesia, prophylaxis, restorations, surgical refinements, and minor adjustments.
- Where a materially new or unrelated treatment is indicated, additional consent shall be obtained.
- This consent remains valid until revoked in writing.
Primary Procedure(s) Authorized:
View attached online case file for documentation
Legal Basis: Medical & Dental Practitioners Act §16; Evidence Act §93–94.
Clause 2 – Scope of Authorization
- HMO: Subject to HMO rules, but I remain personally liable where approvals are denied or delayed.
- Private: Subject to clinic policies and prevailing professional rates.
Legal Basis: Contracts Act; Constitution S.44.
Clause 3 – Financial Responsibility & Refunds
Billing begins with HMO approval or invoice issuance. Once treatment commences, no refund is claimable. Withdrawal or absence creates liability for the full sum.
Legal Basis: Contracts Act; Evidence Act 2011 S.84.
Clause 4 – Treatment Risks & Expectations
All dental procedures carry inherent risks such as pain, swelling, infection, or sensitivity. Pre-existing conditions manifesting after care do not constitute negligence.
Legal Basis: Constitution S.17(3)(c); MDCN Ethics (2004).
Clause 5 – Warranty
Six (6) months on procedures; one (1) year on appliances. Limited to repair or replacement only.
Legal Basis: Sale of Goods Act 1893 S.14 (by analogy).
Clause 6 – Practitioner Duty & Liability
Services rendered per MDCN standards; clinic not insurer of outcomes; liability limited to indemnity cover.
Legal Basis: Medical & Dental Practitioners Act §16; Constitution S.33; Insurance Act 2003.
Clause 7 – Release, Waiver & Indemnity
I release and hold harmless Platinum Dental Surgery from claims arising from recognized procedural risks, except gross negligence proven in court.
Legal Basis: Evidence Act 2011 S.83; Common Law – Volenti non fit injuria.
Clause 8 – Conduct & Defamation
False or malicious complaints (verbal, written, or online) attract civil or criminal liability.
Legal Basis: Constitution S.39; Criminal Code S.373–375; Cybercrimes Act 2015 S.24.
Clause 9 – Dispute Resolution & Arbitration
Complaint → Mediation at LMDC → Binding Arbitration under Arbitration & Mediation Act 2023.
Legal Basis: Arbitration & Mediation Act §§1–3, 33; Constitution S.6.
Clause 10 – Governing Law & Jurisdiction
Governed by Nigerian law and enforceable in Lagos State High Court.
Legal Basis: Constitution S.272; Evidence Act 2011.
Clause 11 – Service Operations Charge (SOC)
Mandatory SOC covers sterilisation, anaesthesia, consumables, lab charges & disposables.
Management may waive partially or fully at discretion.
Legal Basis: Contracts Act; Evidence Act 2011 S.84.
Clause 12 – Signature Authorization
My wet-ink (handwritten) signature shall be scanned, digitized, and uploaded to the Clinic’s secure electronic records and shall be deemed original and binding across all present and future consents, treatment plans, and related documentation. I irrevocably authorize its application to all relevant clinical and administrative forms for identification, continuity of care, and medico-legal record-keeping, subject to applicable data-protection laws.
Legal Basis: Evidence Act 2011 §§93–94; Electronic Transactions Act 2015 §18; Data Protection Act 2023 §§24–26.
Clause 13 – Audio Documentation
Key parts of consultation and treatment planning may be discreetly audio-recorded for accuracy and accountability.
Legal Basis: Evidence Act 2011 S.84; Constitution S.37 & S.39.
Clause 14 – CCTV Usage
CCTV monitors administrative order, staff security, and patient safety. Footage may serve as evidence.
Legal Basis: Constitution S.37; Data Protection Act 2023 S.24.
Clause 15 – Limitation of Complaint & Non-Transferability
Consent applies only to specified procedures; new issues need fresh consent and billing; rights non-transferable.
Legal Basis: Evidence Act S.84; Contracts Act; MDCN Rule 29; Cybercrimes Act S.24.
Clause 16 – Follow-Up Attendance & Continuity
Failure to return within 12 months closes file; restarts require reactivation fee. Plans may change over time.
Legal Basis: Contracts Act; MDCN Rule 29; Evidence Act S.84.
Clause 17 – Post-Treatment Clinical Report
Non-routine treatments include written diagnosis, procedure, observations & recommendations as part of permanent record.
Legal Basis: Evidence Act S.84; MDCN Ethics; Data Protection Act 2023.
Clause 18 – Verified Consent & Financial Commitment
No procedure shall begin without dual consent and confirmed payment or approval.
Legal Basis: Medical & Dental Practitioners Act; Evidence Act S.93–94.
Clause 19 – Uncooperative Patients
Clinic may decline care for uncooperative or abusive patients.
Legal Basis: MDCN Rule 29(b).
Clause 20 – Diagnostic Compliance
Patient cannot compel omission of diagnostic tests; refusal = assumed risk.
Legal Basis: Contracts Act; Evidence Act S.84.
Clause 21 – Multi-Opinion & Transfer Patients
Multiple opinions during active care undermine trust; outside treatments require fresh records and consent.
Legal Basis: MDCN Rule 29(a)(b); Evidence Act S.84.
Clause 22 – Radiographic Prerequisite & Risk Awareness
All surgical extractions require panoramic (OPG) X-ray; close proximity to nerves demands conservative approach.
Legal Basis: MDCN Duty of Care; Bolam v Friern Hospital (1957).
Clause 23 – Patient Duty of Disclosure & Follow-Up
Patients must report changes promptly; failure = contributory negligence.
Legal Basis: Tort Law; Evidence Act S.84.
Clause 24 – Clinic’s Right to Disengage
Clinic may withdraw if patient is hostile or under third-party influence. Not abandonment.
Legal Basis: MDCN Rule 29(c); Constitution S.39.
Clause 25 – Documentation & Evidentiary Rights
All records (including emails, texts, audio) form part of the official medical record and are admissible in court.
Legal Basis: Evidence Act S.84; Cybercrimes Act S.24.
Clause 26 – Treatment Continuity Beyond Primary Plan
Where new findings arise during care, the Clinic may recommend additional procedures subject to fresh authorization.
Legal Basis: Medical & Dental Practitioners Act §16; Contracts Act.
Clause 27 – Patient Competence & Voluntariness
I affirm that I am of sound mind and body, fully oriented in person, place, and time, and under no coercion or undue influence to undergo any dental procedure.
Legal Basis: Constitution S.34(1); Evidence Act 2011 S.93–94; MDCN Code of Ethics Rule 29.
Clause 28 – Expectation & Stepwise Treatment Acknowledgment
Patient agrees that treatment follows structured steps; skipping or rushing stages is at their own risk.
Legal Basis: Medical & Dental Practitioners Act §16; Evidence Act S.83–84.
Clause 29 – Cosmetic and Aesthetic Limitation
Outcomes may vary due to anatomy or healing; aesthetic dissatisfaction does not imply negligence.
Legal Basis: MDCN Rule 29; Contracts Act.
Clause 30 – Appliance Fabrication & Multi-Visit Treatment Protocol
Covers CAD/CAM planning, 6–8 visits, laboratory coordination, and patient cooperation expectations.
One-year warranty on appliances; skipping visits voids warranty.
Legal Basis: MDCN Ethics 2004; Evidence Act §§83–84; Contracts Act.
This document, having been vetted, endorsed, and ratified by external counsel, carries full contractual and evidentiary weight under Nigerian law and is admissible before any court or the MDCN.
This Agreement is governed by Nigerian law and is enforceable in the High Court of Lagos State. Copies of clinical records, audio recordings, CCTV footage and signed consent documents may be retained by the Clinic and used for continuity of care or legal proceedings, subject to applicable data protection laws.
