I Mr./Mrs./Ms. give informed consent to Dr. Aniket Ingale for any such treatment to me/my ward as may be required in the interest of me / my wards Oral & Dental health and under any anesthesia deemed suitable if required for the procedure.

I understand that necessary information will be given to me from time to time on every proposed treatment procedure and I have been explained about limitations & consequences of the procedures.

I agree to pay the fees for above treatment procedures and will abide by it.

I give consent for any change in anesthesia / treatment plan deemed necessary by the doctor at the time of medication / Investigation / procedure / therapy.