Amy Mathew D.M.D.

2883 North Decatur Road Decatur, Georgia 30033

404-299-7411

Consent For Fillings

Dear Patient,

We want to inform you of our policy regarding filling material and associated costs. We only do Composite fillings (white/tooth colored). We do not provide Amalgam (silver fillings). The advantages for composite fillings include but are not limited to:

Better esthetics
No Mercury
Less removal of natural tooth structure

While Insurance Companies are aware of the benefits some still pay for Amalgam only. In that case, it is the patient’s responsibility to pay the difference between Amalgam and Composite. If you wish to have a silver filling, your alternative option is to change to a provider who uses this material. This document confirms you understand your treatment options. If you have any questions, please do not hesitate to ask the Doctor or the front Desk Staff.

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