Dental X-Ray Consent Form


Dental X-rays allow the dentist to diagnose and treat conditions that cannot be detected during a clinical examination. Dental x rays detect much more than just cavities. for example, x rays may be needed to diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. If dental problems are found and treated early, before they become visible or painful, dental care is much more comfortable and affordable. Dental x rays are part of comprehensive examination. I hereby authorize the performance of diagnostic x-rays. Below mention Dentist has requested the x rays for further diagnostic purposes.
Patient Name & Signature :   

Doctor/Therapist Name & Signature :   


Parent or Gaurdian Name (if patient is minor) :

Date :