BEFORE YOUR APPOINTMENT: 1) You must arrange to have an escort drive you to and from the appointment and stay with you. You should NOT go home by public transit. 2) Do not wear facial makeup or nail polish. Wear comfortable, casual and loose fitting clothing. Wear a short sleeve shirt, so we can monitor your blood pressure. 3)Contact us prior to the appointment if there has been a change in your general health (such as fever, severe cold, COVID-19, flu, etc). 4) Nothing to eat or drink for 8 hours before the dental appointment. 5) Make a trip to the washroom just prior to being seated in the dental chair. 6) Do NOT take any other sedatives, calming medications before coming to the appointment. This includes taking medications the night prior to your appointment. This can greatly interfere with your sedation. 7) If you have any questions prior to the appointment, do not hesitate to call our office at (289)-447-1680. * Yes, I read and acknowledge this No Name Of The Escort To And From Appointment * Escort's Relationship To The Patient * Escort's Phone Number * FOLLOWING YOUR APPOINTMENT: 1) You must NOT drive a car or operate machinery for at least 18 hours after the dental procedure. You may feel drowsy for the remainder of the day and should be recovering at home in the care of a responsible adult until you are fully alert. 2) Do NOT travel by public transit. 3) Do not drink any alcoholic beverages for 18 after the dental procedure was completed. 4) If there are any questions, do not hesitate to call our office at (289)-447-1680 * Yes, I read and acknowledge this No Consenting Signature * Patient or Patient's Parent/Guardian Name First Name Last Name Name of Patient Receiving the Sedation Treatment If Under 18 Years of Age First Name Last Name Date * MM DD YYYY Thank you!
