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Consent Agreement
By selecting the options below and submitting this form, I am acknowledging that I have received, understand and accept the following that was provided to me by KW Prosthodontics.
Treatment Estimate
Financial Arrangements
Consent for Prosthodontic Treatment
Consent for Implant Surgery

​By clicking Submit Agreement, you have are indicated that you have been informed and agreed to the treatment as discussed.

All images on this site have been taken by Dr. Burgoyne or Dr. Wong and used with patient's permission . No images have been enhanced or altered beyond cropping, rotation, and/or brightness levels.

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© 2022 Kitchener Waterloo Prosthodontics

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