Informed Consent: X-Rays

 

Dentist’s Name: Danielle Zeifman
 X-rays:

Proposed treatment: taking of extra-oral radiographs. Benefits of treatment: taking x-rays enables us to view dental cavities, abnormalities, development and eruption of teeth. They are also necessary for proper diagnosis and evaluation purposes. Alternatives of treatment: none; limited visual examination will NOT be sufficient in diagnosing or treatment planning. Common risks: radiation exposure to soft and hard tissues. Consequences of not performing the treatment: missed diagnosis.

Common Risks

Exposure to x-ray radiation.

By signing below, you acknowledge that you have received adequate information about the proposed treatment, that you understand this information and that all of your questions have been answered fully.

 YES - 
 ​​​​NO - 
 Our consultation, x-rays and photos are complimentary and used for Dr. Zeifman’s diagnosis purposes.  Should you like a hard copy of your x-ray, it would be $75.00 per x-ray.