One parent is permitted to remain with each child during treatment (excluding sedation appointments). Dr. Crews will discuss with you the terms and conditions for this privilege. Other guests/siblings must remain in the waiting area accompanied by an adult.
We request that 24-hour notice be given if you cannot bring your child for their scheduled appointment. You will be charged a $25.00 fee for broken appointments when illness is not a factor and 24-hour notice is not given.
I have read and fully understand the above Appointment and Cancellation Policy and accept all provisions.
I request and authorize Dr. Jay Crews to examine, clean, and provide dental treatment on my child's teeth including but not limited to the use of local anesthetic and/or nitrous oxide ("laughing gas"). I further request and authorize the taking of dental x-rays as may be considered necessary by Dr. Crews to diagnose and/or treat my child's dental problem. I will allow photographs to be taken of my child or child's teeth for diagnostic or education purposes. I understand that dental treatment for children includes efforts to guide their behavior by helping them to understand the treatment in terms appropriate for their age. Dr. Crews will provide an environment likely to help children to learn to cooperate during treatment by using praise, explanation and demonstration of procedures and instruments, and using variable voice tone. I will be responsible for any charges incurred on this child for dental treatment.