Oral Sedation

My obligations for Conscious Oral Sedation:

I have read and understood the risks and complications which may occur in connection with this procedure. I understand that the potential risks are not limited to those described above. I agree that I have been given and understood enough information to give my consent for the above procedure and to any other treatment or service deemed necessary or advisable. I have had the opportunity to ask questions and all such questions have been answered to my satisfaction. I have given a full and accurate report of my medical history, including allergies, conditions, medications and history of illness. I authorize and agree to undergo the procedure.