Letter Of Decline X Ray

X ray consent withheld i have voluntarily elected not to have diagnostic radiographs taken to help with the diagnosis and treatment planning of my dental condition. Digital radiography is even lower than that.

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This is being done against the recommendation of my dentist.

Letter of decline x ray. Patients refuse radiographs for many different reasons including fear of radiation discomfort and even religious reasons. I do not hold my dentist liable for any failure to diagnose or any misdiagnosis due to lack of the recommended x rays. I have voluntarily elected not to have this diagnostic procedure performed.

Refusal of necessary x rays. Preview and approve online. I was informed of the need for diagnostic x rays.

I do not hold the above named dentist liable for any failure to diagnose or any misdiagnoses due to the lack of the recommended x rays. In situations where x rays are warranted and the patient refuses due to financial reasons i advise the doctor to provide them at no charge if the doctor is unwilling to terminate the patient relationship. A dismissal letter should also be sent to the patient with wording emphasizing failure to treat some dental conditions may result in permanent irreversible damage to your dental health offering appropriate care for patients is a basic function of a dental practice and dental x rays are a necessary requirement for accomplishing this.

This is being done against the recommendations of the above named attending dentist. Protect patients and your practice by having patients sign and date a consent form. Fear of radiation although x ray machines vary the amount of actual radiation is anywhere from 1 to 5 of a second for one periapical exposure an extremely small amount.

Tear off two sheets at a time so when patients sign they can take a copy home and you can file the original.

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