DISCLAIMER: The Informed Consents listed below are for informational purposes only and do not constitute a legal opinion. They are provided as a service to our Members as a template for their private use, to be modified as the provider deems appropriate. Please call the Trust office with questions.
Cosmetic Evaluation Form
Cosmetic Treatment including Bleaching, Whitening, Bonding, and Veneer
Crown and Veneer Cosmetic Consent
Informational Informed Consent Whitening Consent
Informational Purposes Only Cosmetic Treatment
Patient Information and Consent Form for Cosmetic Dentistry Cosmetic Reconstruction
Whitening Consent
COVID-19 Consent Form 2
COVID-19 Consent Form for reopening
COVID-19 Door Sign Reopen
COVID-19 Pandemic Period
COVID-19 Treatment Consent
COVID Door Sign
COVID When scheduling
When scheduling during COVID-19
Denture Cosmetic Consent Agreement
Denture Service
Dentures and Partial Dentures
Final Approval for Denture Construction
Full Artificial Dentures and Partial Dentures
Immediate Complete Dentures and Partial Denture
Temporary Denture Agreement
Wax try in agreement
Apicoectomies
Endodontic Root Canal Therapy Informed Consent
Endodontic Surgery
Endodontic Treatment
Endodontic Treatment 2
Endodontics
RCT Consent Form
Root Canal Retreatment
Root Canal Treatment - Your Next Steps
Bisphosphonate Consent for Treatment
Cosmetic Treatment including Bleaching, Whitening, Bonding and Veneer
Consent to Leave Messages/Share Information with Family & Friends
Cracked Tooth
Financial Agreement
General Dentistry
Health History
Occlusal Equilibration
Occlusal Sealants
Whitening Consent
A Realistic Approach to My Treatment
Classification of Peri-Implant Disease by NOCO Perio
Dental Implant Surgery
Dental Implants
Home Care Instructions Following Implant Surgery
Implant Maintenance Protocol by NOCO Perio
Implant Surgery
INSTRUCTIONS PRIOR TO Implant Placement
Maxillary Sinus Augmentation
Periodontics Protocol Monitoring Periodontitis
Periodontics Protocol Referral Considered by NOCO Perio
Home Care Instructions After Laser Treatment
Laser Ablation New Attachment Procedure Laser ANAP
New Technology New Confort
Post LANAP Diet
Bisphosphonate
Maxillary Sinus Augmentation
Informed Consent for Oral Surgery
Informed Consent to Perform Oral Surgery
Oral Biopsy
Oral Surgery
Oral Surgery and Dental Extractions
Oral Surgery Pediatric Patient
Post Operative Oral Surgery Instructions
Pre-operative Surgical Instructions
Functional Orthodontic Appliances
Invisalign
Orthodontic Treatment
Orthodontics Potential Risks and Limitations
Nitrous Oxide Pediatric Patient
Occlusal Sealants
Oral Surgery Pediatric Patient
Pediatric Dentistry
Pediatric Informational Informed Consent
Photograph Consent (child)
Classification of Peri-Implant Disease by NOCO Perio
Implant Maintenance Protocol by NOCO Perio
Laser Ablation New Attachment Procedure Laser ANAP
New Technology New Comfort
Periodontal Procedures Scaling and Root Planing Information
Periodontal Procedures Scaling and Root Planing Informed Consent
Periodontal Surgery
Periodontal Treatment Consent
Periodontics Protocol Monitoring Periodontitis
Periodontics Protocol Referral Considered by NOCO Perio
Post LANAP Diet
Photograph Consent (child)
Photographic Waiver and Consent
Photography Release and Consent
Waiver and Consent
Consent to Occlusal Equilibration v2
Cosmetic Treatment including Bleaching, Whitening, Bonding and Veneer Informed Consent
Cracked tooth
Crown and Bridge Prosthetics
Crown and Veneer Cosmetic Consent
Patient Information and Consent Form for Cosmetic Dentistry Cosmetic Reconstruction
Removal of Crowns and Bridges
Root Canal Treatment - Your Next Steps
Consent and Request for Dental Sedation
Escorting the Sedation Patient
IV Conscious Sedation
IV Sedation Anesthesia
IV (Intravenous) Sedation Information and Consent Form
Minimal Sedation Log
Nitrous Oxide
Nitrous Oxide Analgesia
Nitrous Oxide Pediatric Patient
Oral (Enteral) Sedation
Patient Evaluation Sedation
Patient Information Prior to IV Sedation
Post Op Sedation and Restorative Instructions
Safety Checklist ADSA
Sedation and Anesthesia Record
Sedation Record
Simple Oral Sedation Record