Dental Implant Consent Form
Patient Information
Full Name
Date of Birth
Contact Number
Procedure Information
Implant Location(s)
Notes
Acknowledgements
I have been informed about the dental implant procedure and its purpose.
I understand the potential risks, benefits, and alternatives to dental implants.
All my questions about the procedure have been answered.
I have received and understand the post-operative instructions.
I have provided a full and accurate medical history.
Consent
I voluntarily consent to undergo the dental implant procedure. I understand I may withdraw my consent at any time before the procedure has begun.
Patient Signature
Date
Dentist Signature
Date
Witness Signature
Date