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 are currently working with a digital platform called “Weave” to make our paperwork process more eco-friendly. Prior to your appointment, you should receive a digital link via text message that will direct you to an online portal for your paperwork to be completed PRIOR TO YOUR APPOINTMENT. Upon arrival for your appointment(s), we will ensure all paperwork has been collected before your child is able to be brought back for any treatment. In order for a 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 / insurance member ID and group ID#.. Some of this information will be collected prior to the child’s visit to aid in the verification of the patient’s dental insurance, and the remainder will be collected at the time of appointment to document who is bringing the child to the appointment. Failure to provide the requested information at the appropriate time could result in cancellation or rescheduling of the appointment to a later date.
Download our Williamson Pediatric Dentistry Brushing Calendar to help your children keep track of their daily brushing!