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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
  • oxy
  • Red Bull
  • Mirvac

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

Included Features

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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!

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