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Dental Insurance Information

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Are you currently taking or have you ever taken the following medications?

If you are taking birth control pills, antibiotics may inactivate birth control medication. Therefore, if you are taking antibiotics, additional birth control methods should be used until your next menses.

Permission For The Following Procedure: the undersigned, consent to the performing of whatever Endodontic Procedure (Examination, X-Ray, Root Canal, Apico Surgery, etc.) that may be decided upon to be necessary or advisable in the opinion of the Doctors. I also understand that I am to return to my dentist for permanent restoration of the treated teeth as soon as possible.


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