Office-based general anesthesia requires a full and thorough medical history in order to be as safe and predictable as possible. It is absolutely necessary that you report any and all medical conditions, medications, allergies, surgeries, or hospitalizations your child has ever experienced in your pre-op paperwork. Failure to disclose any of the above information may result in serious injury or death of your child at worst, and same-day cancellation of your appointment at best.
I affirm that I will provide a clear and thorough medical history for my child. I understand that failure to disclose any health information my result in my child's surgery being delayed and/or cancelled.
It is your responsibility to know and understand your dental insurance benefits. We will verify dental coverage as a courtesy to you, but you are responsible for any copays or changes to the estimated amount based on treatment changes during your child’s surgery. Any estimated copays must be paid in full 10 days prior to surgery. Failure to do so will result in cancellation of your child's appointment.
If your child's treatment changes during their surgery due to new decay or the progression of existing decay, any change to your copay is your responsibility. We will send you an invoice with an updated copay that must be paid within 30 days.
I understand that my child's copay must be paid 10 days prior to their scheduled surgery. I understand that I am responsible for the difference if there is a change to my child's treatment.
You may also have an additional copay for the anesthesia portion of your child's dental surgery. Any anesthesia-related copays are paid directly to CarePoint or AMC and must also be paid prior to surgery. Their team will contact you for payment, which is also subject to change if your child's surgery requires more time than originally anticipated.
I understand that anesthesia is billed separately from the dental procedures and must be paid prior to my child's surgery date.
For the safety of our patients, all anesthesia appointments scheduled to begin after 11:30 AM will have an arrival time of 11:30 AM. This helps limit access to food and drink at home and supports compliance with NPO guidelines. It also allows our team the flexibility to move your child’s procedure earlier if there are cancellations or if we are running ahead of schedule.
All anesthesia appointments are intentionally scheduled with a built-in time buffer to accommodate the unpredictable nature of anesthesia care. Please understand that arrival time does not equal procedure start time. Earlier surgery times are never guaranteed, and delays in start times can occur unexpectedly.
I acknowledge that I have read, understand, and agree to comply with the anesthesia scheduling policies outlined above.
Anesthesia appointments are a limited and highly coordinated resource requiring dedicated clinical time, staffing, and preparation. To ensure fairness and safety for all patients, we maintain a strict compliance policy:
Because surgery appointments are a limited resource, we maintain a zero-tolerance policy for families who do not adhere to these requirements.
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