I, the undersigned, confirm that the above details are true and correct and by my signature attached hereto accept and agree to abide by terms and conditions contained hereunder. My signature also gives informed consent for any procedures which may be required.
I understand that I am fully responsible for my account, not my medical aid. I also understand that I am to settle the account immediately after my appointment.
Any accounts that haven't been settled will be handed over to our attorneys for collection. You will be held liable to pay any collection and/or attorney fees on the Attorney Client Scale.
I understand that there are CCTV cameras on the property for the safety of both myself and The Family Dentist team. I understand and agree that in the event that footage is required by authorities, it will be handed over.