13802 W Camino del Sol Suite #101Sun City West, AZ 85375
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I hereby authorize Dr. Matthew Harmon to administer local anesthetic and remove the following teeth:
The consequences of not performing necessary extractions may include:
Though rare, the following complications may occur during or after dental extractions:
I understand that tooth extraction is an elective procedure, and there are often alternative treatments, such as a root canal and restoration, or performing no treatment at all. My dentist has described
other options (including tooth replacement) invited me to ask questions, and I am electing to proceed with the extraction.
I will follow the verbal and written postoperative instructions and return for a follow-up appointment if requested.