In connection with the initial examination and subsequent treatments / consultation (if any) at The Multi-Specialty Clinic of the Institute for Advanced Dentistry (IAD-MSC) of myself / my child / the person concerned, I hereby declare (on behalf of my child / the person concerned) that:
就本人/本人子女/當事人* 在香港大學先進牙醫學研究所 – 專科診所(診所)的初步口腔檢驗及其後的牙科治療/會診(如適用),本人謹此(代表本人子女/當事人)聲明: