X Ray Refusal Form Dental

X Ray Refusal Form Dental - I understand that the doctor will refuse to treat. I have been advised to have the following radiographs (x‐rays) taken as part of a complete and thorough exam, in order to assist in diagnosing dental/oral conditions that may be. Doctor has informed me of the need for the dental radiographs, risks associated with not taking radiographs, and my refusal to take radiographs. These conditions may include but not limited to tooth decay, gum disease, infections, cysts, and tumors. I understand that the radiographs are necessary for my dentist to diagnose and treat. Not diagnosing them early could result.

I have been advised to have the following radiographs (x‐rays) taken as part of a complete and thorough exam, in order to assist in diagnosing dental/oral conditions that may be. Doctor has informed me of the need for the dental radiographs, risks associated with not taking radiographs, and my refusal to take radiographs. I understand that the doctor will refuse to treat. These conditions may include but not limited to tooth decay, gum disease, infections, cysts, and tumors. Not diagnosing them early could result. I understand that the radiographs are necessary for my dentist to diagnose and treat.

I have been advised to have the following radiographs (x‐rays) taken as part of a complete and thorough exam, in order to assist in diagnosing dental/oral conditions that may be. I understand that the doctor will refuse to treat. Doctor has informed me of the need for the dental radiographs, risks associated with not taking radiographs, and my refusal to take radiographs. These conditions may include but not limited to tooth decay, gum disease, infections, cysts, and tumors. Not diagnosing them early could result. I understand that the radiographs are necessary for my dentist to diagnose and treat.

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Doctor Has Informed Me Of The Need For The Dental Radiographs, Risks Associated With Not Taking Radiographs, And My Refusal To Take Radiographs.

I have been advised to have the following radiographs (x‐rays) taken as part of a complete and thorough exam, in order to assist in diagnosing dental/oral conditions that may be. I understand that the radiographs are necessary for my dentist to diagnose and treat. Not diagnosing them early could result. These conditions may include but not limited to tooth decay, gum disease, infections, cysts, and tumors.

I Understand That The Doctor Will Refuse To Treat.

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