Dental Veneer Consent

Dental Veneers Consent

I have been informed and understand that dental veneers are available to certain dental patients.
These veneers are made of a ceramic/resin material and are bonded to the enamel of my teeth using resin cement.

I wish to undergo this procedure as a patient of

Dentist Name

and they have given me the option of a specialist referral for this procedure.My dentist has shown me a mock up of the contour of my veneers . I have opted to go ahead with the shade:

Shade

I realize that this shade is lighter than my other natural teeth. I am happy with the appearance of the mock up and therefore consent to my teeth being trimmed back to allow for placement of the veneers.
I understand that my dentist will keep the preparations on my teeth to a minimum to achieve best aesthetics. I have been informed that veneers bond to the tooth enamel and if the quality and quantity of enamel on my teeth is poor, we might need to consider crowns for the teeth. My dentist has advised me about the following post-operative issues with veneers.

Veneers can de-bond from the natural teeth occasionally. In such instance, if intact the same veneer can be re-cemented onto the tooth at an additional cost. However, if this happens a number of times, we then need to consider a remake or a crown for the tooth.The will incur an additional cost.

Hard food substances can cause veneers to fracture.

My habit of night grinding can cause damage to my veneers and I will therefore have to wear the provided night guard.

I will need to maintain regular recall hygiene maintenance to ensure that the veneers and the supporting teeth are healthy.

The veneering process will need removal of the tooth structure.

Resin veneers can change colour with time and will need replacement every 3-5 yrs.

My treating dentist is solely responsible from any claims that might arise from this procedure. Having been fully informed of the above, I hereby knowingly consent to the recommended dental veneer and crown treatment outlined to me by my dentist and request him/her to place veneers and crowns on my teeth for aesthetic enhancement.

I further state that I have carefully read this consent form and understand the contents

First Name

Last Name

Signature

Sign Here

Date / Time

    
 
 
        
   Anton Nicosia 
 25/11/2022
 
 
  Great dental team - friendly, helpful & explained everything to me.
  
 
       
   Christa Michaelis 
 11/07/2022
 
 
  I had a tooth fitted with a crown today, following removal of an old filling. This was the second crown i had done here within eight months, in between I had my teeth cleaned and a filling as well. I can't speak highly enough of all the team members I have met, -dentists, technicians and reception staff. Everybody is friendly and competent.  Procedures are carried out gently and painlessly, with a lot of consideration for patient comfort. A very impressive 3-D-printer-like piece of machinery (see picture) enables the team to manufacture crowns in-house which means you don't have to attend twice. Can't wait to go back - already booked my next appointment ! 😉
I highly recommend Encounter Bay Dental to anyone in need of dental work!
  
 
       
   Brian Thorpe 
 04/06/2022
 
 
  Very good experience. Had root canal work done on infected tooth. Was able to get in the day after I phoned for an appointment. Would have had to wait 2 weeks to get in to see local dentist. Dentist very professional and explained procedure being done. Will definitely change to this dentist for any future work.👍👍👍
  
 
       
   julie jordan 
 14/04/2022
 
 
  Was fitted in at short notice with a very troublesome tooth. I can’t speak more highly about every aspect of the care taken & attention given to a fairly complex situation. Top notch! Highly recommended & I’ll be back!
  
 
       
   Cindy Headon 
 13/12/2021
 
 
  Professional, compassionate an EXCELLENT Customer Service.
"It's a YES from Me" !!!
Thank you so very much Georgia and Cipi. With thanks so very much and Regards,
Cindy 😆😆😆
  
 
       
   Mork 
 25/10/2021
 
 
  I am a new client as we just moved in down the road and so very happy with the quality of the work and all the staff where wonderful. Cheers
  
 
       
   Ramsey June 
 02/10/2021
 
 
  Had a really good experience, no fuss got the job done, friendly dentist, would recommend
  
 
  
 
  
 
   Google rating score: 4.0 of 5, based on 12 reviews