• Pediatric Dentistry




  • Date Format: MM slash DD slash YYYY
  • Please enter a number from 0 to 50.
  • Required to send the filled forms to you.
  • I hereby authorize and direct the dentists of THE LITTLE TEETH WORKSHOP and/ or dental auxiliaries of his/her choice, to perform upon my child (or Legal ward) the following dental treatment or diagnostic aids.
    1. Cleaning of teeth and the application of topical fluoride.
    2. Postponing or delaying treatment at this time.
    I understand that there are risks involved in this treatment and hereby acknowledge that these risks have been explained to me, that I have had an opportunity to ask questions regarding the treatment and the risks and that I fully understand the same. By typing my name below I give consent to The Little Teeth Workshop and Dr.Iyer to perform the necessary dental procedures needed.