I, the under signed, authorize Royal Oak Smiles to perform any necessary dental services and oral surgery that I may need during my diagnosis and treatment with my informed consent. I certify that the medical and dental histories provided are accurate and complete to the best of my knowledge. I also understand that any and all dental services are my sole responsibility and that I should make myself aware of any fees associated with my dental care prior to treatment. Also, I, also acknowledge that there is no expressed, implied or guarantee of any procedure or dental treatment provided.