Gaining consent from patients and documenting either their decision to proceed, or their refusal, is a critical component of the dental record. I am provided with this refusal form and information so I may understand the recommended treatment and the consequences of refusing treatment.Dentists must obtain informed consent for every treatment you propose and perform on patients or from the patient's legal guardian or decision-maker. The Company reserves the right to refuse to provide services to any of its clients at its sole discretion. Incorrect claims for free or reduced cost NHS dental services will result in a penalty charge of up to £100, in addition to the cost of NHS dental services. Encourages them to fill out and send in a LIS application. 2. PA is a request for a service from your doctor. Your PCP will help you to get PA if it is necessary. Privacy Policy for our practice (hereinafter "the company"). We follow a very strict privacy policy.