Consent and Financial Agreement Form
Understanding and agreeing to treatment terms, financial responsibility, and privacy policy.
Read the form carefully
Review and Sign
Before proceeding with any treatment, it’s essential to understand and consent to our terms. This form outlines financial responsibilities, treatment plans, and privacy policies for your acknowledgment and agreement.
Our Dental Office has Plenty to Offer
You and your family can obtain your complete dental treatment here at one convenient location by Dr. Barrilleaux.
Some of our specialty services include:
- ARoot Canal Treatment on ALL Teeth
- ACustom Dentures "See and feel the difference"
- AImplants to Attach Dentures
- AImplants to Replace Teeth
- ATreatment for Gum Disease
- ABone and Tissue Regeneration
- AFull Mouth Reconstruction
We treat people, not just teeth.
Same Day Emergency Dentistry! Always accepting new patients!
We are your one stop Dental Shop!
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Contact Us Today!
Whether it’s routine check-ups or complex treatments, we have got your back. Our clinic is open Monday, Wednesday, and Friday from 9:00 AM to 5:00 PM. Feel free to give us a call at (256) 451-7242 to book your appointment with our dentist at Section and take the first step towards achieving your perfect smile.
