Common Contracts
1 similar Financial Agreement for Anesthesia Services contracts
FINANCIAL AGREEMENT FOR ANESTHESIA SERVICESFinancial Agreement for Anesthesia Services • March 27th, 2018
PATIENT INFORMATION Patient Name: Contact Number: Date of Procedure: Email: Your dentist has estimated treatment time to be: hour(s) minutes Total Anesthesia time = Dentist’s treatment time PLUS 60 minutes (30 minutes induction and 30 minutes recovery) Anesthesia Time: Estimated Anesthesia Fee:
