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:

1. I have read and fully understood the “Notice to Members of Public Who Intend to Seek Dental Treatment from IAD-MSC (version dated 2018.10)” and “Statement of Collection of Personal Information from Patients” before registration;
2. I hereby consent to and authorise IAD-MSC or University of Hong Kong / third-parties to use all or any anonymized photographs, radiographs, scan images or study models taken of me / my child / the person concerned, for the purposes of education, research records and/or publication;

Functions of IAD-MSC

3. I understand that IAD-MSC is a teaching clinic and will not provide public dental services. All treatments of teaching patients are wholly geared to the training of Postgraduate students of Faculty of Dentistry of The University of Hong Kong (the Faculty), dental ancillary students, or staff of the Faculty / IAD-MSC;

Initial Examination Process

4. I / My child / The person concerned agree(s) to be examined in the course of a screening process. I understand that IAD-MSC will not provide any dental treatment or follow-up if I / my child / the person concerned have / has not been accepted as a teaching case after examination. In that case, I will accept without any claim against IAD-MSC that I / my child / the person concerned shall have to seek further dental or medical attention or treatment elsewhere;
5. I understand that waiting time for the screening and examination process may vary, and that there is no guarantee that admission as teaching patient would be offered to me / my child / the person concerned. I understand that, during the period of the screening and examination process and before I / my child / the person concerned am / is accepted as a teaching patient, IAD-MSC will not provide any dental treatment or follow-up. Should any symptom or health condition arise during such period, I / my child / the person concerned should promptly seek treatment dental or medical attention or treatment elsewhere in order to avoid any health risk resulting from delay in seeking treatment;
6. I am aware that the initial examination is likely to be time-consuming and will usually require a whole morning or afternoon session;

Subsequent Treatment / Consultation Arrangements (if any)

7. If I am / my child / the person concerned is accepted as a teaching patient, I understand that the waiting time will depend on the needs of the relevant teaching programmes and the nature and type of the dental problems, varying from several weeks to several years, and that during such waiting period I / my child/ the person concerned should consider seeking dental or medical attention or treatment elsewhere in order to avoid any health risk resulting from delay in seeking treatment;
8. I understand that in view of the teaching requirements, each appointment for treatment / consultation is likely to be time-consuming and will usually require a whole morning or afternoon session;
9. I understand that IAD-MSC has the absolute right to cease further treatment or follow-up if IAD-MSC considers that the dental problems of me / my child / the person concerned are no longer suitable for teaching purposes or for further examination by IAD-MSC. In that case, I accept without any claim against IAD-MSC that I/ my child/ the person concerned shall have to seek further dental or medical attention or treatment elsewhere;
10. I accept without any claim against IAD-MSC that IAD-MSC has the absolute discretion to discharge me / my child / the person concerned from the care and attention provided at IAD-MSC for reasons such as failure to attend a scheduled appointment on time twice, absence without giving one working day’s prior notice, refusal to receive further treatment, failure to be contacted, failure to follow the treatment schedule, non-compliance with the recommended treatment plan/ dental advice, or having unreasonable expectations, etc.; and I understand that this is not an exclusive list, and the ultimate decision to discharge a patient rests with IAD-MSC;
11. I understand that in the case of emergency, IAD-MSC may advise me / my child / the person concerned to seek further dental or medical attention or treatment elsewhere, which I will accept without any claim against IAD-MSC;
12. I understand that I / my child / the person concerned have/ has to use the dental consumables, dental appliances or dental materials provided by IAD-MSC, and I shall have no claim against IAD-MSC due to any loss and damage arising from the inherent defects of such materials;

Fees and Charges

13. I understand that there is no refund of Attendance Fee even if I / my child / the person concerned am / is not accepted as a teaching case or if I / my child / the person concerned am / is discharged by IAD-MSC;
14. I agree to pay the fees and charges of IAD-MSC as prescribed in the Schedule of Fees which I understand may vary from time to time. I accept without any claim against IAD-MSC, that if I fail to settle the fees within the specified period, IAD-MSC has the absolute right to discharge me / my child / the person concerned from the care and attention provided at IAD-MSC; and
15. I understand that I should not accept any demand notes or receipts issued by individual staff of IAD-MSC / the Faculty outside the invoicing system of IAD-MSC; and that all IAD-MSC fees and charges must be paid to IAD-MSC’s front desk directly, but not to any other staff.