I hereby certify that my answers to the forgoing questions are accurate. Since a change in my medical conditions or medications can affect dental treatment, I agree to take the responsibility to notify the dentist of any changes at any subsequent appointment. You authorize Dr. Adam P. McLachlan, and/or the staff at Dr. McLachlan’s office to perform those procedures agreed upon and within the standard of care on you (or at your request, to your minor child or ward). We commit to informing you about all procedures. We encourage you to diligently ask us if you have any questions about any procedures or their necessity, for we want you completely comfortable through the entire process.