Note:

• Clinic has followed guideline for “Control and Prevention of COVID-19 spreading” advised by The Dental Association of Thailand.

• If you have COVID-19 infection later, no matter from anywhere, clinic will not be responsible for any such complaints or compensation.

• The “real” information must be provided by you. If not, you will be fined and/or jailed according to Thai Law.

I hereby confirm that information given above is “true” and I already understand any risk that might be. I sign my name to accept all the condition above.