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PERIODONTICS
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PERIODONTICS

Forms for Periodontics:

 
4periodontaldiseaseeval30.JPG Periodontal Disease Evaluation Form
$10.00
Periodontal Disease Evaluation Form
 
3periocleaningsmpl30 Informed Consent for Perio Prophylaxis
$10.00
Informed Consent for Perio Prophylaxis
 
2periosmpl30 Informed Consent for Periodontics
$10.00
Comprehensive Informed Consent for Periodontics: Complies with TSBDE Rule 108.7 which requires that Texas dentists maintain a written informed consent signed by the patient, or a parent or legal guardian of the patient if the patient is a minor, or a legal guardian of the patient if the patient has been adjudicated incompetent to manage the patient's personal affairs. Such consent is required for all treatment plans and procedures where a reasonable possibility of complications from the treatment planned or a procedure exists, and such consent should disclose risks or hazards that could influence a reasonable person in making a decision to give or withhold consent.
 
2bGUMGRAFTSMPL30 Gingival Augmentation/Gum Graft Surgery
$10.00
Gingival Augmentation/Gum Graft Surgery:
The purpose of gingival augmentation is to create an amount of attached gum tissue adequate to reduce the likelihood of further gum recession, or to cover exposed root surfaces, enhance the appearance of the teeth and gum line, or prevent/treat root sensitivity or root decay.
Complies with TSBDE Rule 108.7 which requires that Texas dentists maintain a written informed consent signed by the patient, or a parent or legal guardian of the patient if the patient is a minor, or a legal guardian of the patient if the patient has been adjudicated incompetent to manage the patient's personal affairs. Such consent is required for all treatment plans and procedures where a reasonable possibility of complications from the treatment planned or a procedure exists, and such consent should disclose risks or hazards that could influence a reasonable person in making a decision to give or withhold consent.

 
2periosmpl30 Periodontal Surgery - Patient Education
$5.00
Periodontal Surgery - Patient Education
 
2periosmpl30 Gingivitis - Patient Education
$5.00
Gingivitis - Patient Education
 
2periosmpl30 Spanish: Informed Consent for Periodontal Cleaning
$10.00
In Spanish: Informed Consent for Periodontal Cleaning:
Complies with TSBDE Rule 108.7 which requires that Texas dentists maintain a written informed consent signed by the patient, or a parent or legal guardian of the patient if the patient is a minor, or a legal guardian of the patient if the patient has been adjudicated incompetent to manage the patient's personal affairs. Such consent is required for all treatment plans and procedures where a reasonable possibility of complications from the treatment planned or a procedure exists, and such consent should disclose risks or hazards that could influence a reasonable person in making a decision to give or withhold consent.

 
2periosmpl30 Spanish: Informed Consent for Periodontics
$10.00
Comprehensive Informed Consent for Periodontics (in Spanish):
Complies with TSBDE Rule 108.7 which requires that Texas dentists maintain a written informed consent signed by the patient, or a parent or legal guardian of the patient if the patient is a minor, or a legal guardian of the patient if the patient has been adjudicated incompetent to manage the patient's personal affairs. Such consent is required for all treatment plans and procedures where a reasonable possibility of complications from the treatment planned or a procedure exists, and such consent should disclose risks or hazards that could influence a reasonable person in making a decision to give or withhold consent.