xv

Informed Consent
For the study


I,Mr/Ms.S/o,/D/o..
R/o ..
have been informed about the procedure, all the benefits and the possible
associated complications during and after the surgical procedure. I am
willingly participating in the study conducted by the Department of
PERIODONTOLOGY.

1. I have been informed about the possible complications and I dont
have any objection.
2. For my benefit if post-operative follow up investigations are required,
I will co-operate.
3. If at any point I wish to drop out from the study, I shall inform.



Date : Signature of Patient


Place : Signature of Parents/Guardian