New River Valley Dental
 
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X-Ray Agreement

At New River Valley Dental, we are very concerned with radiation safety. Appropriate protective lead shields are always provided to you. We work in the office around x-ray units all day, every day. We have a vested interest in taking only necessary x-rays for both your health and ours.

We use digital x-rays in our office. Digital x-rays use 60% less radiation than traditional “film” x-rays and they are friendlier to the environment because there are no harsh processing chemicals to discard.

We can only see 50% of your oral conditions without x-rays. X-rays allow us to see, among other things, in between the teeth, below the margins (edges) of fillings and crowns, the location and density of the bone around the teeth, and pathology within the jaws. With this information we can make a full diagnosis, treating little or hidden problems before they become severe.

If you are unwilling to take x-rays as deemed necessary by the doctor or hygienist, we ask that you do not become a patient at New River Valley Dental as your refusal compromises our ability to fully diagnose your condition and provide you with optimal dental care.

I agree to x-rays as necessary for my dental treatment.

Notice of Deemed Consent to HIV Blood Testing

Should an employee be exposed to my blood/body fluid in a way that might allow transmission of infection due to blood borne disease (eg. HIV, Hepatitis, etc) or other communicable diseases; I understand that according to VIRGINIA STATE LAW for the safety, health and possible treatment of our employee, samples of my blood or body fluid may be tested for evidence of infection. I also understand that NEW RIVER VALLEY DENTAL employees and dentist are obligated to submit to blood tests for certain infectious diseases (eg. HIV, Hepatitis, etc.) if I am inadvertently exposed to their blood or body fluid during the course of my treatment in the office.

I have read and understand the above statement.

Name (Signature)
Date

 

New River Valley Dental
1400 S. Main St.
Suite 1401
Blacksburg, VA 24060
540-951-2260
Scheduler@NRVDental.com
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