ENAMEL REDUCTION CONSENT FORM

Dr. Roy E. Scott DDS | Dr. Roy E. Scott DDS Inc. has explained enamel reduction or “reproximation” treatment.

Interproximal enamel removal is a procedure to remove a small amount of enamel between and around the teeth to create space for the correction of crowded teeth and to enable the teeth in each dental arch to come together more efficiently.

This is accomplished with a hand-pulled strip or low speed hand-piece, and will not require anesthesia since the procedure is pain-free.

The details of the procedure have been described to me by Dr. Roy E. Scott DDS | Dr. Roy E. Scott DDS Inc. after consultation regarding my particular orthodontic treatment plan and needs.

By signing this document, I give my consent to Dr. Roy E. Scott DDS | Dr. Roy E. Scott DDS Inc. to perform enamel reduction.

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I acknowledge that the procedure has been explained to me in full, I understand the details of the procedure and I have had the opportunity to ask questions.

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