Medium

Available on

Apple Android Windows

Patient Information and Consent Form for Cosmetic Dentistry/Cosmetic Reconstruction Mobile App

This app is a consent form for cosmetic dentistry. It gives the dentist authorization to perform the dental reconstruction and outlines the risks. A patient signature in this app ensures you minimize misunderstandings regarding this procedure.

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

Want to learn more about GoCanvas?

Request a Demo
Take a Tour

Take a peek inside the Patient Information and Consent Form for Cosmetic Dentistry/Cosmetic Reconstruction Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

  • {{data.title}}

Included Fields

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

  • Ico textbox

    Patient

  • Ico date

    Date

  • Ico statictext

    I, , authorize and request Dr.

  • Ico statictext

    I also authorize and direct my doctor(s), with associates or assistants of his (their) choice, t...

  • Ico statictext

    Alternatives to cosmetic dentistry / cosmetic reconstruction have been explained to me, includin...

  • Ico statictext

    I am aware that the practice of dentistry and cosmetic dentistry/cosmetic reconstruction is not ...

  • Ico statictext

    (Description in layman terms of the specific cosmetic procedure and anesthetic to be used).

  • Ico statictext

    As with any dental procedure, there are possible complications of which you must be aware.

  • Ico statictext

    only done for my cosmetic interest but there are dental conditions that if left untreated, the f...

  • Ico statictext

    I agree not to operate a motor vehicle or hazardous device for at least hours or more until full...

  • Ico signature

    Patient Signature

  • Ico date

    Date

  • ...and More!

Related Health Care & Social Services Apps... and they're all free for GoCanvas subscribers!

App Name

Dental Infection Prevention Checklist

The Dental Infection Prevention Checklist mobile app should be used to ensure the dental health care setting has appropr...

App Name

Dental Appointment Card A3982 - DA

The Dental Appointment Card A3982 - DA mobile app offers a simple way to generate electronic appointment reminders for you...

App Name

Dental Equipment Service Report

The Dental Equipment Service Report mobile app provides a simple way to track dental equipment repairs electronically. Des...

App Name

Dental OSHA Emergency Exit Routes

Are you prepared in case an emergency evacuation is needed? It is important to have escape routes in your workplace for OS...

App Name

Dental Hygienist Job Description - Bu...

The Dental Hygienist Job Description - BusinessFormTemplate.com mobile details the responsibilities and qualifications for...

App Name

Dental Insurance Information Form - M...

This app gathers the information from the patient's insurance and therefore authorizes the dentist to perform work under t...

App Name

Consent for Crown and Bridge Prosthetics

Crown or bridgework may be indicated to fix a tooth for a variety of reasons such as a crack in the tooth, existing crown ...

App Name

Patient Inform Consent for Implant Re...

This mobile app is an electronic consent form for implant restoration. It describes the two procedures; inserting the impl...

More Information

Related Blog Posts