I have received a copy of The Dental Board of California's Dental Materials Fact Sheet. (Revised 05/04)

Yes, I acknowledge receiving the Dental Materials Fact Sheet

My dentist has explained the reasons for recommending a specific type of dental restoration material.

Yes, the explanation was provided

I have discussed the pros and cons of amalgam restoration with my dentist.

Yes, amalgam restoration was discussed

If I have had unusually sensitive reactions to other materials in the past, I have discussed this sensitivity with my dentist prior to restoration work.

Yes, I have discussed any sensitivity issues

I have had a chance to ask any questions I may have, and have received satisfactory answers to those questions.

Yes, all my questions were answered satisfactorily