At Williamson Pediatric Dentistry, your child’s dental health is our number one priority. While we understand that patients sometimes have to be accompanied by someone other than their parent or legal guardian to an appointment due to conflicts such as work, illness, etc…., consent must be obtained from the parent prior to the child’s scheduled appointment if anyone else is bringing them.
If your child will be accompanied by anyone other than the legal parent or guardian to their appointment, please download the form below and complete it in its entirety and either email it to firstname.lastname@example.org, fax it to 615-614-2426, or bring it to the office prior to or at the time of the child’s appointment. This form will allow you to give that specific person the ability to make a decision our your behalf in the event treatment were to change for your child, as well as the ability to have any necessary paperwork updated in the event of your absence. Thank you for your cooperation in ensuring the safety and well-being of all children at Williamson Pediatric Dentistry.
We have recently partnered with a company called Enlive Dental to make our paperwork process more eco-friendly. When you arrive to the office, an iPad will be presented to you at check-in. This kiosk will allow you to provide us with the appropriate information necessary in order to see your child for their dental visit. In order for the patient to be seen, the parent or legal guardian of the child must provide us with a copy of their driver’s license, as well as their date of birth and social security number. This information will be utilized to aid in the verification of your child’s dental insurance and to document who is bringing the child to the appointment. Failure to provide the requested information at the time of the appointment or prior to could result in cancellation or rescheduling of the appointment to a later date.
Eventually, we will be able to send you a digital link to a secure site after your new patient appointment is scheduled on the phone where you can complete most of your needed paperwork online before ever coming to the office. This is in the works and we are excited to bring this feature when we are able to do so!!!
Download our Williamson Pediatric Dentistry Brushing Calendar to help your children keep track of their daily brushing!