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Available on

Apple Android Windows

Tooth Extraction Consent Form Mobile App

This consent form app has been created for dental professional, and covers information on alternative treatments, post surgery, and possible complications. Please read carefully. This app can be customized to meet your Dental practices specific requirements.

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

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Take a peek inside the Tooth Extraction Consent Form Mobile App

Included Features

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Included Fields

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

  • Ico checkbox

    After careful oral examination, a review of radiographs and study of dental condition, Dr.

  • Ico checkbox

    no treatment, root canal therapy, filling, a crown, and/or gum treatment.

  • Ico checkbox

    bruising, and stiff jaws, all of which may last for several days.

  • Ico checkbox

    tongue, chin, teeth, and mouth may occur but are very rare.

  • Ico checkbox

    and non-prescription, which I take, and any known drug allergies.

  • Ico textbox

    Patient Signature (print)

  • Ico textbox

    Tooth #’s to be extracted

  • Ico textbox

    Dr.

  • Ico signature

    Patient Signature

  • Ico date

    Date

  • Ico signature

    Witness Signature

  • Ico date

    Date

  • ...and More!

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