High Risk Consent Form

I have been explained and have understood that the proposed treatment is uncommon / complicated / risky.I have been explained and have understood that the proposed treatment is based on technique / procedure / drug / protocol that is relatively new.I have been explained and have understood that the proposed treatment has high rate of failure...

Medical Photography Consent

I, the undersigned, do hereby state and confirm as follows:

I consent to photographs being taken for my medical records. I consent to the photographs being made available to other clinicians involved in my treatment. I consent to my photographs being used for teaching purposes provided these are anonymised. I consent to my photographs being used for the Website provided these are anonymised.

Anaesthesia Consent Form

I, the undersigned, do hereby state and confirm as follows:

I have been explained the following in terms and language that I understand. I have been explained the following in {{LANGUAGE}} (name of the language or dialect) that is spoken and understood by me.
I have been explained; I have been provided with the requisite information; I have understood; and thereafter I consent, authorize and direct the above named principal anesthetist ...

Extraction Consent Form

I understand that oral surgery and/or dental extractions include inherent risks such as, but not limited to the following:

Injury to the nerves: This would include injuries causing numbness of the lips, the tongue, and any tissues of the mouth and/or cheeks or face. The numbness which could occur may be of a temporary nature, lasting a few days, a few weeks, a few months, or could possibly be permanent...

Implant Placement Surgery Consent Form

Dental implants are devices that are surgically placed in the jaw that become attached to the bone as substitutes for natural tooth roots. Implants permit missing teeth to be replaced through the use of crowns, fixed bridges, or dentures, which attach to the top of the implant.
This recommendation is based on visual examination, on any X-rays, models, photos and other diagnostic tests taken, and on my doctor’s knowledge of my medical and dental history. My needs and desires have also been considered...

Endodontic (Root Canal) Services Consent Form

Root canal therapy is indicated when the pulp chamber of a tooth is contaminated by bacteria causing the canals to become infected. The procedure is accomplished when the dentist creates a small opening in the biting surface of the tooth that will allow it to be disinfected and then sealed with an inert rubber-like substance. The sealing of the canals prevents subsequent passage of bacteria into or out of the tooth. I have been informed that the risks to my health if this procedure is not performed may include....                                                                                                                                                                                                                                       

General Consent Form

I, the undersigned, do hereby state and confirm as follows:

I have been explained the following in terms and language that I understand. I have been explained the following in {{LANGUAGE}} (Language) that is spoken and understood by me.
I have been provided with the requisite information; I have understood; and thereafter I consent, authorize and direct the above named doctor-in-charge and his / her team with associates or assistants...