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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.

  • Lendlease
  • The Cooperative
  • PG&E
  • oxy
  • Red Bull
  • Mirvac

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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.

  • Ico textbox

    Patient Name

  • Ico textbox

    I hereby authorize (Doctor Name)

  • Ico textbox

    and any associates to perform the following procedure

  • Ico statictext

    The doctor has explained to me the proposed treatment and the anticipated results of such treatment.

  • Ico statictext

    The doctor has explained to me that there are certain potential risks in this treatment plan or p...

  • Ico statictext

    Injury to a nerve resulting in numbness or tingling of the chin, lip, cheek, gums and/or tongue ...

  • Ico statictext

    Postoperative infection requiring additional treatment.

  • Ico statictext

    Opening of the sinus (a normal cavity situated above the upper teeth) requiring additional surgery.

  • Ico statictext

    Restricted mouth opening for several days or weeks, with possible dislocation of the temporomand...

  • Ico statictext

    Injury to adjacent teeth and fillings.

  • Ico statictext

    In rare circumstances, cardiac arrest or breakage of the jaw.

  • Ico statictext

    Postoperative discomfort, swelling, and bleeding that may necessitate several days of recuperation.

  • Ico statictext

    Decision to leave a small piece of root in the jaw when its removal would require extensive surg...

  • Ico statictext

    Stretching of the corners of the mouth with resultant cracking and bruising.

  • Ico statictext

    Unforeseen conditions may arise during the procedure that require a different procedure than set ...

  • Ico statictext

    I understand that the medications, drugs, anesthetics and prescriptions taken for this procedure ...

  • Ico statictext

    It has been explained to me and I understand that a perfect result is not guaranteed or warrantied.

  • Ico statictext

    Please don’t hesitate to ask the doctor or staff if you have any questions.

  • Ico signature

    Patient, Parent or Guardian Signature

  • Ico signature

    Doctor Signature

  • Ico date

    Date

  • ...and More!

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