Dental Service Agreement

PERIODONTAL DISEASE: You understand that periodontitis is a serious disease that causes inflammation of the gums and bones and/or loss and can lead to the loss of your teeth. You understand alternative treatments for the correction of periodontitis, including gum surgeries, dental extractions with or without replacement. You understand that performing dental procedures can have adverse effects on your periodontal condition in the future. The member and the patient are responsible for providing accurate information, provided knowingly on the Internet, in our application or in forms and historians of dentistry and medicine, and for updating all demographic information, including insurance coverage information, in the dental record. You received and read a copy of the Dental Board of California`s Dental Materials Fact Sheet. You understand that dentistry is not an exact science and that no dentist can properly guarantee the results. You hereafter authorize one of the doctors or dental assistants to perform restorations and dental treatments as explained. Services provided under this agreement. Responsibility of members and patients: the party bears its own costs, its own costs related to such arbitration, and the parties share the arbitrator`s fees in the same way. Judgment on an arbitral award resulting from such an arbitration procedure may be submitted to any competent court.

If this arbitration provision is considered invalid, the parties agree that the court of regular and exclusive jurisdiction, in order to resolve all actions arising from that agreement, is a state or federal court established in San Francisco, California. EACH PARTY TO THIS AGREEMENT HEREBY WAIVES ANY RIGHT HE, SHE, OR IT MAY HAVE TO PARTICIPATE IN ANY CLASS ACTIONS OR CLASS ARBITRATIONS. The dominant party has the right to recover its legal fees and fees, as determined by the arbitrator. This agreement and the exhibits, if any, represent the entire agreement of soothing dental, and the member and patient with regard to the purpose of this agreement. There are no other conditions, commitments, alliances, representations or declarations. Previous or subsequent written or oral agreements or agreements that relate to them are valid or have an effect or effect, unless they are signed in writing and signed by the parties. o Explore your dental insurance to find out if the dental practice is networked or networked and if the benefits are available to patients. PLAN TREATment MODIFICATIONS: You understand that it may be necessary to modify or add procedures during treatment because conditions are found during work on teeth.

For example, root canal therapy according to routine restoration methods. You give the dentist permission to make any changes and supplements to your treatment plan if necessary. Reassuring Dental will usually contact you via the email address or phone number you provided to Soothing Dental. In certain circumstances, we may contact the member and patients via the postal address or other contact information provided by Soothing Dental. The member and patient can contact Soothing Dental for any issues related to affiliate services or dental services that we make available with the following resources: with your account, for the remaining balance payable thirty (30) days ago, and you will receive a confirmation of payment in the form of a receipt or confirmation of a transaction. This agreement can be executed in one or more counterparties, each of which is considered original, but which together constitutes the same instrument. This agreement enters into force with the implementation of a counter-instrument by each of the parties. FILLINGS: You understand that chewing should be careful, especially during the first 24 hours, to avoid fractures.