WEBthorough deliberation, I hereby consent to the performance of surgical extractions as presented to me during consultation and in the treatment plan presentation or as describe in this document. I also consent to the performance of such additional or alternative procedures as may be deemed necessary in the best judgment of my periodontist.
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Informed consent and permission form - extractions
WEBBefore you give your permission for the removal of teeth, removal of impacted teeth (those that are “buried” or beneath the gums) other dental treatment, or the administration of certain anesthetics, you should understand that there are certain associated risks. We will be extracting teeth #(s) _____________________________________ Common ...
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Informed Consent For Tooth Extractions & Oral Surgery
WEBIt has been recommended that I have the following tooth (teeth) extracted by Dr. _________________________: _________________________________________________________________________________________. The extraction is necessary because of: Pain Infection. Tooth is not restorable.
WEBTOOTH EXTRACTION INFORMED CONSENT Patient’s Name: _____ _____ Date of Birth: _____ Page 1 of 2 Patient Initial _____ This form and your discussion with your doctor are intended to help you make informed decisions about your surgery. As a member of the treatment team, you have been informed of your diagnosis, the planned procedure, the …
WEBINFORMED CONSENT DISCUSSION FOR EXTRACTIONS. Patient Name: . Date: . DIAGNOSIS: Facts for Consideration. Patient’s initials required. An extraction involves removing one or more teeth. Depending on their condition, this may require sectioning the teeth or trimming the gum or bone tissue.
WEBINFORMED CONSENT FOR EXTRACTION(S) 1. I, _____, hereby authorize and request that Dr. _____ and his assistants perform the following extractions on teeth/tooth number(s) _____. 2. I am aware that an extraction involves the surgical removal of the tooth structure and root system of that tooth and surrounding bone and tissue.
WEBDISCUSSION & INFORMED CONSENT FOR EXTRACTION(S) Rev 07/2019. FACTS FOR CONSIDERATION. An extraction involves removing one or more teeth. Depending on their condition, extraction may require sectioning (dividing) the …
WEBINFORMED CONSENT FOR TOOTH EXTRACTION. I (Patient Name) ______________________________herby authorize Dr. ______________________________ (herein called Doctor) to perform tooth extraction of tooth/teeth # __________________________ on myself. Extraction of teeth is an …
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Oral Surgery and Dental Extractions Informed Consent
WEBInjury to the nerves:This could include injuries causing numbness of the lips; the tongue; any tissues of the mouth; and/or cheeks or face. This numbness which could occur may be temporary, lasting a few days, a few weeks or a few months. It could possibly be permanent, and could be the result of surgical procedures or anesthetic administration.
WEBDec 14, 2018 · INFORMED CONSENT FOR TOOTH EXTRACTION. Teeth maybe recommended for extraction (tooth removal) for a number of reasons, such as infection, breakage, abscess, and future treatment planning.
