{"id":3179,"date":"2022-05-03T19:01:31","date_gmt":"2022-05-03T19:01:31","guid":{"rendered":"https:\/\/cotegilbert.com\/nouveau\/patient-zone\/consent-form\/"},"modified":"2022-05-05T18:33:14","modified_gmt":"2022-05-05T18:33:14","slug":"consent-form","status":"publish","type":"page","link":"https:\/\/cotegilbert.com\/en\/patient-zone\/consent-form\/","title":{"rendered":"Consent form"},"content":{"rendered":"<p>[vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221;][vc_column][vc_single_image image=&#8221;2928&#8243; img_size=&#8221;full&#8221;][\/vc_column][\/vc_row][vc_row hide_bg_image_on_tablet=&#8221;&#8221; hide_bg_image_on_mobile=&#8221;&#8221; css=&#8221;.vc_custom_1651770296241{margin-top: 40px !important;margin-bottom: 80px !important;}&#8221;][vc_column][vc_empty_space height=&#8221;10px&#8221; alter_height=&#8221;none&#8221; hide_on_desktop=&#8221;&#8221; hide_on_notebook=&#8221;&#8221; hide_on_tablet=&#8221;&#8221; hide_on_mobile=&#8221;&#8221; css=&#8221;.vc_custom_1651602698418{margin-top: -0.25rem !important;}&#8221;][vc_custom_heading text=&#8221;Consent form&#8221; 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indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_9'  action='\/en\/wp-json\/wp\/v2\/pages\/3179' data-formid='9' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_9_5\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p><strong>File: <\/strong>I consent to the collection of data, the taking of photographs, video capture, x-rays and necessary impressions before, during and at the end of the treatment, according to the directives of the Order of Dentists of Quebec.<\/p>\n<p><strong>Consent to Use of Record: <\/strong>I give my permission to use my orthodontic record for purposes of consultation, education, research and publication in professional journals.<\/p >\n<p>I acknowledge having read and understood the document entitled <strong>Instructions for orthodontic treatment<\/strong> which outlines the potential risks associated with orthodontic treatment. I have asked all the necessary questions in order to clarify all the areas on which I had questions and I am satisfied with the answers provided. <br \/>\n  I authorize my dentist to proceed with the orthodontic treatment knowing that she is a dental surgeon practicing orthodontics in all of her general practice since September 1992. <\/p>\n<p>I agree to follow the guidelines and consent to orthodontic treatment.<br \/>\n  I understand that the fees for orthodontic treatment only cover orthodontics. 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