from Upper East Smiles, PC (the “Practice”) and voluntarily consent to receive dental services, which may include routine diagnostic and therapeutic dental procedures and routine dental treatment to be provided by duly licensed independent practitioners (L.I.P.) and other personnel. I acknowledge that no guarantees have been made to me as to the results of treatments or examinations by the Practice. I understand that this consent is valid and shall remain in effect unless I revoke it. I understand that this general consent applies to any routine procedure or treatment, such as administration of medication, injections, external examination of the body, including the mouth, use of local anesthesia, and other routine procedures. I consent to the photographing and/or videotaping of the appropriate portions of my/the patient’s body, which are pertinent to showing my/the patient’s physical condition, for medical, scientific or educational purposes, provided reasonable precautions are taken to conceal my/the patient’s identity. I understand that I may ask questions of my/the patient’s L.I.P. and other personnel regarding any aspect of my/the patient’s diagnosis or treatments which I do not understand.