Dentistry On 66

DECLINING XRAYS/RADIOGRAPHS


There are no simple alternatives to the diagnostic ability of a dental x-ray.


X-ray allow us to look within the teeth and jaws to discover abnormalities before they are recognizable by the eye.

It enables treatment to begin at an earlier stage before larger problems may arise.

I am declining the recommended treatment of x-rays against medical advice.

I assume the following potential risks for declining treatment:

  • Undiagnosed cavities between the teeth
  • Possibility of future extractions or root canals from the inability to diagnose cavities at an early stage
  • Possible tumors, cysts, or abcessed teeth found in the jaws
  • Undetected bone loss (used to diagnose periodontal disease)

I hereby release the attending clinicians from any liability for any and all consequences that I may sustain a a result of my
refusing recommended dental treatment.

I understand the possible advantages from proceeding with the recommended treatment and the possible risks and
consequences of refusing the recommended treatment.

I have read and understood the above mentioned information clearly. I voluntarily choose to undergo treatment with
Dr Ziad Al Azawi and give consent to conducting all necessary procedures that has been explained to me for the
replacement of my missing teeth.

do66 DECLINING XRAYS/RADIOGRAPHS
I, _____________ am declining to have any xryas/radiographs taken today at my dental appointment at Dentistry on 66.
I, _____________ am declining to have any xryas/radiographs taken today at my dental appointment at Dentistry on 66.
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