Chairside Request
Warning: by submitting the form, you agree to the terms below.*
*I understand that cancellations or rescheduling of the above appointment must be made at least 48 hours in advance.
If a cancellation or rescheduling occurs within 48 hours of the scheduled date and time, a $250.00 cancellation fee will be charged. By clicking below, I acknowledge and accept full responsibility for supervising the dental technician provided by to assist with chairside conversions, iCam scans, and IOS scan services. As a licensed dentist in my state of practice, I have requested these chairside services and accept complete responsibility for any tasks performed within my office and outside of the dental lab while the technician assists me and my team. I understand that operates under my supervision, insurance coverage, and dental license during these services. I further acknowledge that will not assume any financial or legal responsibility for tasks performed chairside at my request. I acknowledge that I am requesting chairside services and agreeing to the above Chairside Terms and Conditions.