5. I understand that there are risks or limitations to all procedures.
For sedation, these include: (IV Sedation) Atypical reaction to sedative
drugs which may require emergency medical attention and/or hospitalization
such as altered mental states, physical reactions, allergic reactions,
other illnesses, and the inability to discuss treatment options with the
doctor should circumstances require a change in treatment plan.
6. If, during the procedure, a change in treatment is required, I authorize
the doctor and the operative team to make whatever change they deem in
their professional judgment is necessary. I understand that I have the
right to designate the individual who will make such a decision.
7. I have had the opportunity to discuss conscious sedation and have my
questions answered by qualified personnel including the doctor. I also
understand that I must follow all the recommended treatments and instructions
of my doctor.
8. I understand that I must notify the doctor if I am pregnant, or if
I am lactating. I must notify the doctor if I have sensitivity to any medication,
of my present mental and physical condition, if I have recently consumed
alcohol, and if I am presently on psychiatric mood altering drugs or other
9. I will not be able to drive or operate machinery while taking IV sedatives
for 24 hours after my procedure. I understand I will need to have arrangements
for someone to drive me to and from my dental appointment while taking
10. I hereby consent to conscious sedation in conjunction with my dental