(1) No later than one hundred twenty (120) days after the date the regulations required by Section 9-3102 are adopted, a dentist who uses dental amalgam which contains mercury in any dental procedure shall provide, at least one time, to each patient a copy of the brochure adopted by such regulations and a statement that shall be signed by both the dentist and the patient, or the patient's representative, stating that the brochure has been provided to the patient in accordance with the provisions of this Section.