Dental Treatment Consent
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Dental Treatment Consent
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The Dental Treatment Consent form provides documented informed consent for dental procedures ranging from routine restorative work to complex oral surgery. Dental treatment consent has unique considerations including the variety of anesthesia options (local, nitrous oxide, IV sedation, general), the frequency of multi-visit treatment plans, and procedure-specific risks such as nerve damage, sinus communication, and prosthetic complications. This form addresses all of these in a structured, patient-friendly format.
The form captures the specific procedure or treatment plan, the teeth or areas involved using standard dental notation, and the type of anesthesia to be administered. A procedure-specific risk section covers complications relevant to the planned treatment, including infection, prolonged numbness, damage to adjacent teeth, and allergic reactions to dental materials. Patients acknowledge receipt of post-procedure care instructions and understand when to contact the office for complications. For treatment plans involving multiple visits, the form can document consent for the full sequence of planned procedures.
Designed for general dental practices, oral surgery offices, periodontal practices, endodontists, and prosthodontists. The form meets the informed consent requirements of state dental practice acts and the American Dental Association's recommended guidelines. It integrates seamlessly with dental intake workflows and can be paired with the Dental Intake form for a complete new-patient onboarding package.
What's included
- Procedure description with tooth identification
- Anesthesia type selection and risk disclosure
- Procedure-specific complication acknowledgment
- Alternative treatment documentation
- Post-procedure care instruction receipt
- Multi-visit treatment plan consent option
- E-signature capture
Who uses this template
- General dental practices for restorative and preventive procedures
- Oral surgery offices for extractions and implant placements
- Periodontal practices for scaling, root planing, and gum surgery
- Endodontic offices for root canal therapy consent
All form fields
13 fields across 2 pages. Customize any field after signing up.
How to use the Dental Treatment Consent
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Dental Treatment Consent from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.
Setup steps
- 1Choose the template. Find the Dental Treatment Consent in the template library and click “Use this template” to add it to your account.
- 2Customize fields. Add, remove, or reorder any of the 13 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
Is the Dental Treatment Consent HIPAA compliant?
Yes. All Formisoft templates, including the Dental Treatment Consent, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.
Can I customize the fields in this template?
Absolutely. You can add, remove, reorder, or modify any of the 13 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.
How do patients fill out this form?
Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.
Can I send this form automatically before appointments?
Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.
Does this template work on mobile devices?
Yes. The Dental Treatment Consent is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.
Start with this template
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