Liability Waiver


Simple Smile Dental Solutions (S3,, Simple Smile Solutions) relinquishes all responsibility’s of any liabilities involved with improper use of, or any side effects of approved surgical plan and surgical guide based on all files provided to S3 Smiles. It is the clinician’s responsibility to assess guide for final quality control prior to use. 

By completing the form below the signee understands that provides a surgical guide for various dental surgical procedures based on approved plan by the responsible or treating clinician. was provided with information, records, and scans of the patient and were instructed to design the guide to the clinician’s approval. At any time, and for any reason at all, either party could cancel or abort the fabrication of the product or the practice or use of the product. It is therefore the clinician’s responsibility before or during the procedure to determine if there are potential risks that would warrant an aborted procedure.

You hereby agree to indemnify, hold harmless, their officers, directors, employees, and agents and hereby WAIVE, RELEASE AND DISCHARGE them from any and all claims for damages for death, personal injury or property damage which you or the patient may have, or which may hereafter accrue to you or my patient as a result of your participation in the dental oral-maxillofacial surgery. This release is intended to discharge in, their officers, directors, employees, and agents from and against any and all liability arising out of or connected with your own or your patient’s participation in said oral-maxillofacial dental procedure, even though that liability may arise out of negligence, on the part of the persons or entities mentioned above.

You, as the clinician voluntarily agree to assume any and all risks of injury or death, and to release, discharge, and hold harmless, all of the entities or persons mentioned above.

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You are required to complete this waiver prior to us completing your case. If the case is finished, it will not be shipped until this form is completed.

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