Treatment Consent
Which consent are we signing today?
Staff selects the procedure, then hands the tablet to the patient — or texts them the link.
These are signed at the time of treatment, not at intake. Each one records its own identity check, timestamp and document hash.
Step 2
Patient details
Confirm who is being treated.
Vitals — staff entry
Tooth selection *
Tap each tooth being treated. Universal numbering; primary teeth lettered.
No teeth selected
Select at least one tooth
Procedure options
Step 3
Consent
Please read carefully. Initial each section where asked, then sign at the bottom.
Dentist signature — required on this form
Dentist signs above
Consent signed.
Filed to the patient chart in Open Dental.