BHD Moderate Sedation Consent

Please complete the form below; for best results use Google Chrome or Mozilla Firefox browsers.

Consent for Dental Treatment with Minimal or Moderate Sedation

I, the undersigned, hereby consent to the procedure(s) and anaesthesia noted above. I acknowledge that the procedure(s), its implications and possible complications have been explained to me, along with the alternatives including not having any treatment. I understand that the procedures will require minimal or moderate sedation, and I consent to the administration of this by the above-named practitioner. I also understand that during the course of any treatment, unforeseen circumstances may arise that make it advisable for an additional or alternate procedure to be performed, and I also consent to such reasonable additional or alternate procedures being performed on me.

I acknowledge receiving a copy of the pre- and post-operative instructions which have been explained to me. I understand all the advice given to me by my dentist. After my discharge, I will notify my dentist if I experience any acute pain, heavy bleeding from the surgical site, respiratory problems, or any other post-operative problems.

New To The Clinic ?

Blue Heron Dental Group is built on a strong reputation of over 30 years of service to the Ottawa community and the families who live here. Other dentists in the community refer pediatric patients to our clinic due to our experience and reputation when treating children.

Have A Question? Call Us

Book An Appointment

2 + 5 =

Let's Start a Conversation

Clinic HOURS:
Monday 7:30-7:30pm
Tuesday 7:30-3:30pm
Wednesday 7:30-3:30pm
Thursday 7:30-7:30pm
Friday 7:30-3:00pm

Clinic Closed:            Dec 26/27 & 30 

Open Dec 28 & Dec 29 7:30-2:00pm

Back to regular business Jan 2 2023 7:30-7:30pm.

.

Address:
102-1500 Bank street Ottawa, Ontario K1H 7Z2
613-706-4101
Info@blueherondentalgroup.ca