Consent for Dental Surgery
Dental Surgeon: Dr. Stephanie C. Lim
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Email *
Name *
Consenting Adult
Email *
Address *
Phone number *
Surgical Procedure *
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This consent is given after the above has been fully explained in simple, adequate and understandable language to me by the doctors concerned including the risks involved and/or their alternative procedures including the risks involved or potential consequence. I hereby consent to the performance of operations in addition to or different from the one I have given consent to and the application of other alternative procedures which may be considered necessary and advisable in accordance with the wise dictates of surgery. I further consent to the administration of anesthesia which may be considered and deemed proper for whatever procedures that may be done on me.





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IN WITNESS WHEREOF, I hereunto affix my INITIALS (please put your name Initials - example: Jane Doe = J.D.) *
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