This agreement between {name} and Midwest Dental Arts (MDA) is effective {date} and is to remain in effect through the remainder of the calendar year. Any chairside services provided or scheduled for the upcoming calendar year will require an annual signature renewal to be kept on file with MDA to avoid any delays in your chairside services. By signing below, {name}, license #{license} is taking ANY AND ALL responsibility for supervision of the dental technician provided by Midwest Dental Arts to assist with chairside conversion, chairside iCam scans, and chairside IOS scan services. As a licensed dentist in your state of practice, MDA has been called in to assist you at your request. As such, you are accepting ANY AND ALL responsibility for any tasks completed within your office and outside of the dental lab. While assisting you and your team chairside, MDA is operating under your license, your insurance umbrella, and under your licensed supervision. At no point in time is Midwest Dental Arts accepting any financial or legal responsibility for tasks being performed chairside at your office.