Dental implant consent

An informed consent form for dental implant placement. The patient confirms the dentist explained their missing teeth, the plan to place an implant in the jawbone, and the alternatives. It states that no outcome is guaranteed, that the patient is responsible for the fee regardless of insurance, that a second procedure may be needed to expose the implant, and the possible consequences of no treatment.

Review it with the patient at the surgical consultation or before the placement visit, and collect the signature before surgery. The doctor or surgical assistant answers questions, and the signed form is saved to the chart. Keep a copy with the treatment plan and financial agreement.