new lousine v. kirakosian, d.d.s. look dental · patients may require local anesthesia, light to...

INFORMED CONSENT DISCUSSION FOR ANESTHESIA/SEDATION Lousine V. Kirakosian, D.D.S. 125 E. Glenoaks Blvd., Suite 103• Glendale, CA 91207 Tel: (818) 334-3692 Fax: (818) 484-5760 Email: [email protected] www.newlookdentalinc.com New Look Dental

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INFORMED CONSENT DISCUSSION FOR ANESTHESIA/SEDATION

Lousine V. Kirakosian, D.D.S.

125 E. Glenoaks Blvd., Suite 103• Glendale, CA 91207Tel: (818) 334-3692

Fax: (818) 484-5760Email: [email protected]

www.newlookdentalinc.com

NewLookDental

Page 2: New Lousine V. Kirakosian, D.D.S. Look Dental · Patients may require local anesthesia, light to moderate conscious sedation, deep sedation, or general anesthesia for their comfort

New Look Dental Inc.Lousine V. Kirakosian, D.D.S.

125 E. Glenoaks Blvd., Suite 103• Glendale, CA 91207

Tel: (818) 334-3692Fax: (818) 484-5760 • Email: [email protected]

www.newlookdentalinc.com

Name: Signature: Date: / /20

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