Dental Consent

Please read carefully and ask us about anything that isn't clear before you confirm.

Patient's full name (required)Date of birth (required)Email address (required)Treating clinician

The treatment

Which treatment? (required)Which tooth or teeth?Agreed cost

What we discussed

All dental treatment carries some risk. Depending on the procedure this can include pain, swelling, bruising, infection, damage to nearby teeth or fillings, nerve injury causing numbness, sinus involvement, failure of the restoration, or the need for further treatment. Your clinician will have explained the risks that apply to you.

The treatment has been explained to me and I have had the chance to ask questions (required)

The alternatives, including having no treatment, were discussed with me (required)

I understand the risks that were explained to me (required)

I understand the cost and how it will be charged (required)

I understand that no particular outcome has been guaranteed (required)

Medical

Has anything changed in your medical history or medication? (required)

The information I have given is accurate (required)