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Oral Surgery Consent Form Mobile App

There is a consent process for patients who will undergo surgical procedures. This Oral Surgery Consent Form app provides information on oral surgery, captures patient information and signature for informed consent. This oral surgery consent app can be completed by patients easily on any smartphone or tablet.

This is a great way to obtain patient consent with no hassle. The completed consent form is saved as a PDF and emailed to you and stored in the GoCanvas Cloud for you to access at any time.

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Take a peek inside the Oral Surgery Consent Form Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

Patient Name
I hereby authorize (Doctor Name)
and any associates to perform the following procedure
The doctor has explained to me the proposed treatment and the anticipated results of such treatment.
The doctor has explained to me that there are certain potential risks in this treatment plan or p...
Injury to a nerve resulting in numbness or tingling of the chin, lip, cheek, gums and/or tongue ...
Postoperative infection requiring additional treatment.
Opening of the sinus (a normal cavity situated above the upper teeth) requiring additional surgery.
Restricted mouth opening for several days or weeks, with possible dislocation of the temporomand...
Injury to adjacent teeth and fillings.
In rare circumstances, cardiac arrest or breakage of the jaw.
Postoperative discomfort, swelling, and bleeding that may necessitate several days of recuperation.
Decision to leave a small piece of root in the jaw when its removal would require extensive surg...
Stretching of the corners of the mouth with resultant cracking and bruising.
Unforeseen conditions may arise during the procedure that require a different procedure than set ...
I understand that the medications, drugs, anesthetics and prescriptions taken for this procedure ...
It has been explained to me and I understand that a perfect result is not guaranteed or warrantied.
Please don’t hesitate to ask the doctor or staff if you have any questions.
Patient, Parent or Guardian Signature
Doctor Signature
Date
...and More!