DIRECT ACCESS AND TERMS & CONDITIONS

Therapist Name: Lauren Fisher

GDC Registration Number: 173617

Consent for Direct Access Treatment with a Dental Therapist at The Composite Bonding Company

BACKGROUND

The General Dental Council (GDC) permits patients to directly access the services of a dental therapist from 1st May 2013. Previously, a dentist had to see the patient before prescribing any dental treatment to a dental therapist. This has now changed with some exceptions.

It is important to understand the scope of what a dental therapist can and cannot do.

CAN:

• Examination
• Diagnose tooth decay and treatment plan
• Scale and Polish
• Periodontal (Gum) disease treatment
• Taking Radiographs (X-Rays)
• Restoratives (Fillings)
• Extraction of baby teeth
• Cosmetic fillings, including Composite Bonding

CANNOT:

• Prescribe Teeth Whitening
• Root Canal Treatment
• Extractions of adult teeth
• Ceramics (Crowns and Bridges)
• Dentures
• Other complex or advanced dental procedures
• Prescribe Antibiotics
• Orthodontics

Services that cannot be performed by the Dental Therapist, such as complex or advanced treatments, are left to a dentist. We have a cosmetic dentist in the practice who can carry out the following IN-HOUSE:

• Ceramics (Crowns and Bridges)
• Invisalign (Teeth Straightening)
• Teeth Whitening

REFERRAL BACK TO A DENTIST

If an issue beyond a dental therapist’s scope is identified, an additional examination by a dentist may be required. This is because the dental therapist is acting in your best interest and must refer you to the appropriate clinician to complete your treatment.

If you need a referral to a local clinician for services beyond the scope of our dental therapists, cosmetic dentist, and the practice, additional costs will apply for these services. Please note that external dental practices have their own fee structures.

CONSENT

• I understand that Lauren may seek a professional opinion regarding advanced restorative cases, which will be confidential and under GDPR legislation.
• I have read and understood the limitations of direct access and agree to be treated under the direct access arrangements.
• I understand that the dental therapist, Lauren Fisher, is only responsible for treatments within their scope and that regular visits to a dentist may still be required.
• I understand that I am responsible for my own oral health and for finding and keeping regular appointments with my own dentist.

Due to the primarily cosmetic nature of our practice and the limitations within the Dental Therapist’s GDC scope of practice, we do NOT provide emergency appointments. A dental emergency includes

• Severe dental pain
• Uncontrolled bleeding from the mouth
• Trauma to the tooth
• Infection

*Composite bonding breakages are not considered emergencies as they are purely cosmetic.*

For emergencies outside of working hours:

If you have a dental emergency, telephone reception, where possible, during opening hours. You will then be given an appointment at a time appropriate to your needs. If you require emergency care, you will be offered an appointment within 24 hours. If you require urgent care, you will be advised to help manage the symptoms and be seen within 24 hours.

If you have a dental emergency when the practice is not open, please contact the Community Urgent Dental Care Service on Freephone telephone number 0333 332 3800 from 8am to 10pm every day of the year. Outside these hours, please call NHS 111 for urgent advice. For general enquiries, please call us on 0161 795 0591 or direct message us via WhatsApp on 07944 594 263.

COMPOSITE BONDING BREAKAGES:
We are a small team, and Lauren, the clinic owner, is also our primary clinician. If a patient experiences a composite bonding breakage, we will schedule the earliest available appointment. However, if Lauren is on holiday, we have arrangements with our cosmetic dentist to see patients for breakages at his earliest availability.

The cosmetic dentist works at our practice only one day a month. Patients can either wait for his next available day with us if it’s sooner than Lauren’s next availability or visit him at his current practice. Please note that external practices have their own fee structures. If you choose to wait and your treatment is under our guarantee* (T&C applies), there will be no additional charge for the repair when seen at our clinic.

IF DISTANCE IS GOING TO BE AN ISSUE:

Composite Bonding has a risk of breaking/chipping which could be due to different factors – for example; weakening the bond by not wearing the night guard every night. Please consider this if you DO NOT LIVE LOCALLY to us.

Composite bonding requires maintenance, e.g. after your bonding, we see you for a review appointment in 2-3 weeks’ time, we then see you for a Hygiene Maintenance every 3 months for the 1st year where we check the health of your gums, do a scale and polish and superficial stain removal. – Please be aware that Hygiene Maintenance is not the same as a Dental Examination, therefore we would still recommend coming in for a regular examination with us or with your own dentist to examine for decays and prevent dental issues from progressing further.

Case Notes and Clinical Only
I understand that the illustrations/photos requested here, to which I have agreed, will form part of my confidential treatment records only. These will be accessed by employees at The Composite Bonding Company for the purpose of good record-keeping and for reference when treating and creating treatment plans. They may also be shared with other clinicians for case review, referral, or obtaining specialist advice. I fully understand and accept the terms set out above.

THIS IS A MANDATORY REQUIREMENT TO PROCEED WITH TREATMENT

OPEN PUBLICATION
I understand that occasionally my photos could be used for promotional, informative, or marketing purposes to advertise The Composite Bonding Company. I understand that these may be seen by members of the public as well as other professionals. I understand that I may be identifiable from such photos (as photos of teeth, mouth, and face shots will be taken) and give my consent for any/all photos to be used in such a way. If at any time I change my mind, I will inform The Composite Bonding Company, who will remove them immediately.

PLEASE ADVISE US IF YOU WOULD LIKE TO OPT OUT OF YOUR PHOTOS BEING USED FOR MARKETING PURPOSES IMMEDIATELY

TERMS AND CONDITIONS

I, the patient, understand that the session booked is a private service and all charges are payable in advance of my appointment. The Composite Bonding Company has made a services recommendation and has discussed with me the initial assessment and the costs associated with the first appointment. Should I require further appointments, I understand the clinician will discuss a treatment plan and costs in detail.

I understand and agree to the following terms:

• Consultation fees are non-refundable regardless of whether you are eligible for treatment or not.
• If I arrive late for my appointment, I will only be seen for the remaining time allocated.
• We require a minimum of 50% deposit to book any treatments. Without this, we would not be able to offer you the appointment. All payments must be made in advance of an appointment in line with The Composite Bonding Company’s policy.
• If I cancel late (less than 24 hours’ notice) or fail to attend, a minimum of 50% of the appointment cost will be charged, with the exception of the initial consultation where the full fee will be taken.
• If I contact the practice and give at least 24 hours’ notice that I cannot attend my appointment, the prepayment will be transferred to my next appointment.
• If I have two late cancellations or fail to attend within a rolling twelve-month period, it may result in no further appointments with the practice.
• *COMPOSITE BONDING PATIENTS* – If I fail my appointments more than twice or do not keep on top of my 3 monthly hygiene within the first year, I will no longer be eligible for the free 12 month breakage repair for my composites.

• By submitting this form, I consent to my details being used for marketing purposes from The Composite Bonding Company and The Laser, Skin & Body Company.
• Should you wish to opt out, please contact us on WhatsApp 07944 594 263.
• We do not sell data to any third parties, this will be used solely for in-house marketing.