Texas Informed Consent

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Forms for Informed Consent:
On this page: Informed Consent for Extractions, General Dentistry, Crown & Bridge, Dentures, Nitrous Oxide Anesthesia, Endodontics, Periodontics, Local Anesthetic, I.V. Sedation, Implants (2 forms), Teeth Whitening, Multi-Area Treatment (English), Multi-Area Treatment (Spanish), Orthodontics (2 forms), Fixed Prosthodontics, Treatment While Using Oral Bisphosphonates, Bone Regeneration, Botox, Gingival Augmentation/Gum Graft Surgery, Behavior Management Techniques for Pediatric Patients, and Spanish Forms Package.

Informed Consent for Extractions
$10.00
Comprehensive informed consent for all tooth extractions, including blanks for interpreter and dentist signature, as well as blanks to record blood pressure and pulse on date of extraction(s). 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.

Informed Consent for General Dentistry
$10.00
General Informed Consent for Dentistry: Includes blanks to fill in specific procedures to be performed. 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.

Informed Consent for Crown & Bridge
$10.00
Informed Consent for Crown & Bridge: 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.

Informed Consent for Dentures
$10.00
Informed Consent for Dentures: 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.

Informed Consent for Nitrous Oxide Anesthesia
$10.00
Informed Consent for Nitrous Oxide Anesthesia: 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.

Informed Consent for Endodontics
$10.00
Informed Consent for Endodontics: 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.

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.

Informed Consent for Use of Local Anesthetic
$10.00
Informed Consent for Use of Local Anesthetic: Includes blanks to record blood pressure and pulse. 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.

Informed Consent for I.V. Sedation
$10.00
Consent for I.V. Sedation: Includes blanks to record blood pressure and pulse on date of sedation procedure. 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.

Informed Consent for Implants
$10.00
Comprehensive informed consent for implants, including blanks to record blood pressure and pulse on date of procedure. 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.

Informed Consent for Implants & Anesthesia - Long Form
$10.00
Informed Consent for Implants & Anesthesia - Long Form - 3-page comprehensive informed consent for implants, including blanks to record blood pressure and pulse on date of procedure. 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.

Informed Consent for Teeth Whitening
$10.00
Informed Consent for Teeth Whitening: Comprehensive 4-page form. 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.

Informed Consent - Multi-Area Treatment (English)
$10.00
Informed Consent for Multiple Areas of Dentistry (in English): Includes blanks to fill in blood pressure and pulse, as well as specific teeth on which procedures to be performed. Areas of treatment include Oral Surgery, Periodontics, Endodontics, and Crown & Bridge 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.

Informed Consent - Multi-Area Treatment (Spanish)
$10.00
Informed Consent for Multiple Areas of Dentistry (in Spanish): Includes blanks to fill in blood pressure and pulse, as well as specific teeth on which procedures to be performed. Areas of treatment include Oral Surgery, Periodontics, Endodontics, and Crown & Bridge 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.

Informed Consent for Orthodontics - Long Form
$10.00
Informed Consent for Orthodontics - Long Form: Comprehensive 2-page form. 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.

Informed Consent for Orthodontics - Short Form
$10.00
Informed Consent for Orthodontics - Short Form: Comprehensive 1-page form. 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.

Informed Consent for Fixed Prosthodontics
$10.00
Informed Consent for Prosthodontics - Long Form: Comprehensive 7-page form. 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.

Informed Consent for Treatment/Oral Bisphosphonates
$10.00
Informed Consent for Dental Treatment While Using Oral Bisphosphonates. 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.

Informed Consent for Bone Regeneration
$10.00
Informed Consent for Bone Regeneration Procedures: Includes blanks to record blood pressure and pulse on date of procedure. 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.

Informed Consent for Botox(tm) Injection(s)
$10.00
Informed Consent for Botox(tm) Injection(s): 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.

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.