Informed Consent: I have been given the opportunity to ask any questions regarding the nature and purpose of surgical treatment and/or extractions of teeth and have received answers to my satisfaction. I do voluntarily assume any and all possible risks including the risk of substantial harm, if any, which may be associated with any phase of this treatment in hopes of obtaining the desired results, which may or may not be achieved. No guarantees or promises have been made to me concerning my recovery and results of the treatment to be rendered to me. The fee(s) for this service have been explained to me and are satisfactory.
By signing this form, I am freely giving my consent to allow and authorize Dr. Nimet Jinnah and her associates to render any treatment necessary or advisable to my dental conditions, including any and all anesthetics and/or medications.