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Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

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Informed refusal may indicate that you and the patient have different values and expectations. Consider whether it would be best if that patient is dismissed from the practice and referred to another dentist. Example: the patient who refuses a radiograph you believe essential to proper diagnosis and treatment.
You can decline anything you wish. The dentist can't force you to do anything against your wishes. Also, with out proper x-rays, the dental office has the right to decline care.
Washington state resources for complaints The Washington State Department of Health maintains a webpage where you can file a complaint against a healthcare provider or facility. For complaints against an individual doctor, you'll have to go through the Washington Medical Commission.
Thank you very much for considering me for a Dentist position at DentalCare. I appreciate the opportunity to interview, but am writing to withdraw my name from the candidate pool. I wish you every success in your search.
Be Honest and Direct: Explain your reasons for wanting to refuse the treatment. You might say something like: - ``I've been thinking about the crown treatment, and I've decided I would like to withdraw my consent. I appreciate your recommendation, but I have some reservations.''
Just as the patient has a right to refuse any treatment, the dentist has the right to refuse any treatment. As a practicing dentist, I will give the patient the options that I feel are viable, and if they aren't convinced, I will refer them. I have a lot more content patients that way.
Do I need to see the dentist if I have healthy teeth? Yes, even if you take good care of your teeth, going to the dentist should still be part of your routine because even though your teeth look healthy, you likely still have some plaque on your teeth or tartar on your gums that can lead to tooth decay and gum disease.
If a patient refuses definitive treatment, that refusal should be documented, along with the patient's signature on a document that states he or she understands the ramifications of nontreatment. It is the doctor's decision whether to retain or dismiss the patient from the practice.
While you always have the right to refuse, it's likely not in your best interest to do so, and if you declining cleanings causes a decline in your health they may permanently dismiss you as a patient because of the liability it creates for them.