St. Louis Pediatric Dentistry
Now welcoming NEW PATIENTS at our O'Fallon, Des Peres, Chesterfield and Ladue offices!

General Consent for Treatment

State law requires us to obtain your consent for contemplated dental treatment. Please read this form carefully and ask about anything you do not understand. We will be glad to explain it.

1. After consultation with Dr. Evan Reed, Dr. Lindsey Reed, Dr. Amy LeCave, Dr. Danielle West and/or Dr. Jaime Orrick, and an explanation about any proposed procedure, I hereby authorize and direct Dr. Evan Reed, Dr. Lindsey Reed, Dr. Amy LeCave, Dr. Danielle West and/or Dr. Jaime Orrick, assisted by other dental auxiliaries of his/her choice to perform upon my child (or legal ward) the following dental treatment or oral surgery procedure(s) including the necessary or advisable local anesthesia radiographs (x-rays) or diagnostic aids.

2. In general terms the dental procedures may include one or a combination of the following:

  • Cleaning of the teeth and the application of topical fluoride
  • Dental radiographs
  • Application of plastic "sealants" to the grooves of the teeth
  • Intraoral photographs of the teeth
  • Treatment of disease or injured teeth with dental restorations
  • Replacement of missing teeth with a dental prosthesis
  • Removal (extractions) of one or more teeth
  • Treatment of disease or injured oral tissues (hard and/or soft)
  • Treatment of malposed (crooked) teeth and/or developmental abnormalities

Alternative methods of treatment, if any, will also be explained to me, as will the advantages and disadvantages of each. We advised that though good results are expected, the possibility and nature of complications cannot be accurately anticipated and that, therefore, there can be no guarantee as expressed or implied either as to the result of the treatment or as to the cure.

Frequently Asked Questions

While prolonged pacifier, thumb sucking and finger sucking habits can become problematic, most children stop on their own. Encouraging your child to cease the habit by age three will help with future bite and jaw issues. However, should your child struggle with stopping the habit, our Doctors can help! Feel free to discuss any concerns at your child’s next dental visit!

Whether you are new to the St. Louis area or simply looking for a new dentist, we at St. Louis Pediatric Dentistry would like to welcome your children to a fantastic dental experience!

St. Louis Pediatric Dentistry has a fun, positive, and engaging approach to ensure an excellent dental experience for your child or teen! Our offices are designed to make each visit enjoyable, equipped with TV’s in the rooms, tablets, treasure towers, and more! Our doctors have an age appropriate and kid-oriented style, which allows them to get to know each child personally and communicate with parents and children to create a lifetime of healthy smiles. 

Welcome to an office kids love, where every patient, regardless of age, is treated with the latest advances in dental technology!

If you have difficulty using our website, please email us or call us at
View the ADA Accessibility Statement