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1418 7th Street Suite 101
Santa Monica, CA, 90401
310-458-4000
Where artistry meets clinical excellence
Your Custom Text Here
Home
New Patients
New Patient Information
Getting To Our Parking Structure
Why choose us
How we are different
Meet the Doctors
Meet Our Team
Meet The Dental Hygiene Team
Reviews and Testimonials
Dental Procedures
Before/After Photos
Dental Procedures
Media
Office Photos
Instagram
Educational Videos
Spear Patient Education
Contact Us
Blog
Emergency
Consent Video & Form: Crown Placement
Consent Form
SMED Crown Placement Consent Documentation
Name
*
Name
First Name
Last Name
Please re-enter the following in the box below:
*
"I have watched and heard the SMED crown placement consent video and am giving my consent to be operated on"
Initials (first and last)
*
By entering your initials, you are validating the statement above that you have agreed to consent and have watched the video
Date:
*
(mm/dd/yyyy)
Thank you!