Before Sedation

• NO FOOD OR DRINK PAST MIDNIGHT IS PERMITTED WITH THE EXCEPTION OF CLEAR FLUIDS ONLY UP TO THREE HOURS PRIOR (I.E., APPLE JUICE, GINGER ALE, WATER, ETC.).
• NO CLEAR FLUIDS, INCLUDING WATER, ARE PERMITTED THREE HOURS PRIOR TO APPOINTMENT UNLESS OTHERWISE SPECIFIED BY ANESTHESIOLOGIST/DENTIST.
• A RESPONSIBLE ADULT MUST DRIVE YOU TO AND FROM OUR OFFICE FOR TREATMENT. UNDER NO CIRCUMSTANCES MAY YOU LEAVE ON YOUR OWN BY TAXI OR TRANSIT.
• TAKE ALL PRESCRIBED MEDS WITH A SMALL SIP OF WATER AT REGULAR TIMES UNLESS OTHERWISE DIRECTED.
• DO NOT TAKE INSULIN OR ORAL HYPOGLYCEMIC AGENTS PAST MIDNIGHT UNLESS OTHERWISE SPECIFIED BY ANESTHESIOLOGIST/DENTIST.
• DO NOT OPERATE ANY MOTOR VEHICLE OR HAZARDOUS EQUIPMENT FOR AT LEAST 24 HOURS AFTER TREATMENT.

Failure to comply with the above instructions can result in serious illness or death.

Fee

• PATIENTS ARE REQUIRED TO PAY A FEE OF $500.00 TO RESERVE AN APPOINTMENT THAT INCLUDES IV SEDATION/GENERAL ANESTHESIA. WE DO NOT ACCEPT INSURANCE ASSIGNMENT FOR ANY TREATMENT. PAYMENT IN FULL IS DUE DAY OF APPOINTMENT – INSURANCE BENEFITS WILL BE MADE PAYABLE TO THE PATIENT.
• IN THE EVENT OF A CANCELLATION WITH LESS THAN 48 HOURS’ NOTICE OR A FAILED APPOINTMENT, THE $500.00 FEE IS NON-REFUNDABLE.
• THE FEE IS DUE AT THE TIME YOU SCHEDULE YOUR APPOINTMENT.

Download and print these instructions.