Dental Treatment Consent for Minor

Minor's Full Name: Date of Birth: Parent/Guardian Name:

Treatment Consent

I, the parent or legal guardian of the minor named above, authorize and consent to the performance of dental procedures, examinations, and treatments as deemed necessary by the attending dental professional.

Medical History Confirmation

I confirm that all information regarding the minor's medical and dental history has been provided accurately to the best of my knowledge.

Date:

Parent/Guardian Signature