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What the NHS will provide:
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The NHS provides all the treatment necessary to secure and maintain your oral health. There are some treatments (mainly cosmetic) that are not normally available under the NHS and you may choose to have these provided Privately. You may also choose to have some treatments provided Privately as an alternative to NHS treatment. The dentist will discuss these options with you so that you can make an informed decision.
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Replacements free of charge:
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If you are 18 or over and a filling, root filling, veneer, inlay or crown provided by me under the NHS within the last 12 months has to be replaced, you will not be charged if you return to me unless: The treatment was temporary; it was provided against my advice; the replacement is necessary due to an accident; a different treatment is necessary because a satisfactory replacement is not possible. The NHS cover does not apply to any Private treatment you may have.
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Dental treatment charges:
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I want you to understand the treatment being offered and any charges which may apply. Given above is the treatment plan and cost estimate. Within 2 months of completion of the course of treatment, should you require further NHS treatment in either the same or lower band charge, you normally won’t need to pay for it again.
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Treatment on referral:
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With your agreement, it may be necessary to refer you to another dentist under NHS arrangements, for part of your course of NHS dental treatment. Where this happens you will not be asked to pay a further charge for your NHS dental treatment; only one charge will be made by your referring dentist, as outlined below.
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Paying for NHS treatment:
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Patients aged 18 and over normally pay charges for NHS treatments. There is no charge if you are:
• Pregnant or have had a child in the last 12 months
• If you are aged 18 and in full time education
• If you or your partner are named on a current HC2 NHS charges certificate
• If you or your partner are named on a valid NHS tax credit exemption certificate
• If you or your partner receive Income Support, Income-based Jobseekers Allowance or Pension Credit Guarantee Credit
If you are not in any of these groups, but have a low Income, you may still be able to get help with NHS charges. You can get a claim form HC1 from any Social Security office. Please Note: the following benefits do not entitle you to help with health costs; Incapability Benefit; Disability Living Allowance; Pension Credit Savings Credit; Contribution based Jobseekers Allowance.
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Cancelling appointments:
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If you have to cancel an appointment, please give as much notice as possible in order that it may be offered to someone else. If you miss appointments I may be unable to provide you with further treatments.
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Regular care:
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Taking good care of your teeth is important. Come and see me regularly for checkups and advice. Some people need to see their dentist more than others and I shall advise you when to return next.
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If you do not understand any of the above given information please ask at reception.
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PATIENTS DECLARATION
I understand the nature of the proposed NHS treatment services and accept those services and the associated fees as detailed.