General Dental Treatment Consent Form - 121 Dental Care 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your name in the designated field at the top of the form. This identifies you as the patient.
  3. Proceed to the 'Health Information' section. Here, ensure you disclose all relevant medical history and current medications, as this is crucial for your safety during treatment.
  4. In the 'Drugs, latex and medicines' section, read through the information carefully. Acknowledge any allergies or reactions by checking appropriate boxes if available.
  5. Continue through each section, including 'Needle stick', 'Fillings, Crowns and Un-anticipated Root Canals', and others. Make sure to read each statement thoroughly before providing your consent.
  6. Finally, sign and date the form at the bottom. If applicable, have a witness sign as well to complete the process.

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Obtaining general consent means that the patient has given you permission to proceed with treatment and released you from the possibility of being charged with battery. It also gives the dentist permission to perform minor restorative procedures, administer local anesthesia, and bill the patients insurance company.
I acknowledge that no guarantee or assurance has been made by anyone regarding the dental treatment which I have requested and authorized. I have had the opportunity to read this form and ask questions. My questions have been answered to my satisfaction. I consent to the proposed treatment.