FINANCIAL AGREEMENT FOR ANESTHESIA SERVICESFinancial Agreement for Anesthesia Services • January 22nd, 2023
Your dentist has ESTIMATED his/her treatment time to be: Anesthesia time is approximately treatment time plus 30 minutes: Anesthesia fees are:
EPIONE Dental AnesthesiologyFinancial Agreement for Anesthesia Services • November 7th, 2013
ContractFinancial Agreement for Anesthesia Services • September 13th, 2021
ContractFinancial Agreement for Anesthesia Services • December 14th, 2022
FINANCIAL AGREEMENT FOR ANESTHESIA SERVICESFinancial Agreement for Anesthesia Services • July 15th, 2012
The estimated anesthesia fee is based upon the dentist’s estimate of treatment time, anesthesia preparatory time and the patient’s response to the anesthetic used.
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:
FINANCIAL AGREEMENT FOR ANESTHESIA SERVICESFinancial Agreement for Anesthesia Services • November 23rd, 2021
The estimated anesthesia fee is based upon the dentist’s estimate of treatment time, anesthesia preparatory time and the patient’s response to the anesthetic used.
FINANCIAL AGREEMENT FOR ANESTHESIA SERVICE RENDEREDFinancial Agreement for Anesthesia Services • April 14th, 2009
The anesthesia fee estimate is based upon the dentist estimated operating time which will vary with the surgical complexity, anesthesia preparatory time and patient’s individual response to the anesthetic agents used (recovery).
FINANCIAL AGREEMENT FOR ANESTHESIA SERVICE RENDEREDFinancial Agreement for Anesthesia Services • May 18th, 2015
The anesthesia fee is based upon the dentist estimated operating time which will vary with the surgical complexity, anesthesia preparatory time and patient’s recovery time.
FINANCIAL AGREEMENT FOR ANESTHESIA SERVICESFinancial Agreement for Anesthesia Services • April 1st, 2009
Financial Agreement for Anesthesia ServicesFinancial Agreement for Anesthesia Services • November 14th, 2014
The estimate anesthesia fee includes pre-operative examination, 15 minutes to put the patient to sleep and 15 minutes for recovery. The anesthesiologist will be actively monitoring the patient in the operatory room for the full duration of the dental procedure.
FINANCIAL AGREEMENT FOR ANESTHESIA SERVICESFinancial Agreement for Anesthesia Services • June 9th, 2021 • Washington
THIS AGREEMENT is between the undersigned PATIENT/PARENT/GUARDIAN and Dr. Andrea M Fonner, DDS, PLLC and/or Dr. Simon Prior, BDS, PhD, PLLC.
Sue Jean Park, DDS, Inc.Financial Agreement for Anesthesia Services • July 15th, 2012
Financial Agreement for Anesthesia ServicesFinancial Agreement for Anesthesia Services • October 29th, 2004
The anesthesia fee estimate is based upon the surgeon’s estimated operating time. The actual fee will vary with the surgical complexity, the time required by Dr. Matsunaga to consult the patient’s physician if necessary, and the patient’s response to the surgery.
FINANCIAL AGREEMENT FOR ANESTHESIA SERVICESFinancial Agreement for Anesthesia Services • March 9th, 2017
The estimated anesthesia fee is based upon the dentist’s estimate of treatment time, anesthesia preparatory time and the patient’s response to the anesthetic used.
FINANCIAL AGREEMENT FOR ANESTHESIA SERVICESFinancial Agreement for Anesthesia Services • April 1st, 2009
FINANCIAL AGREEMENT FOR ANESTHESIA SERVICESFinancial Agreement for Anesthesia Services • March 27th, 2018
PATIENT INFORMATION Patient Name: Date: Procedure: Estimated Treatment Time: Total Anesthesia Time (Treatment Time + 45 Minutes):
