Informed consent for extractions

A consent form for dental procedures that is set up for extractions. The patient confirms that the dentist explained the condition, the procedure, the risks, the alternatives, and what happens if they decline. It lists risks such as dry socket, gum recession or tissue changes, root fragments or sharp ridges, sinus complications, infection, and damage to nearby teeth or fillings.

Review it with the patient before any extraction and collect the signature before treatment starts. The doctor or assistant should answer questions and note the discussion in the chart, and the front desk can scan the form after the visit.