California's State Legislature requires Dentists to provide each patient with a copy of the Dental Board of California's Dental Materials Fact Sheet. Please read the pamphlet of its contents carefully, if you have any questions we are more then eager to discuss its details with you. As always, we will be using the same quality decision making process as in the past as we decide which restoratives best suit you individual needs.
California requires that you sign this acknowledgement and that the acknowledgement be made a part of your permanent record of dental care.
It is also important that you let us know whenever there is any change in your medical health; particularly adverse reactions to any medications, metals or other environmental substances.
I hereby acknowledge receipt of a copy of The Dental Board of California's Dental Materials Fact Sheet. I have been afforded the opportunity to ask questions and received satisfactory answers to my questions.
