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Form library · DEN-003

Dental consent for treatment

Example only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. This example has not had a separate legal review.

Rules differ by state; check yours.

Australian dental practices taking consent after the dentist has explained the treatment.

The dentist explains the proposed treatment, its main risks and the other options before the patient agrees. Consent can be withdrawn at any time. It is a consent form. It is not a treatment plan, and it does not cover fees.

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Dental consent for treatment

Example only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. This example has not had a separate legal review.

Example only. Fictional practice: Example Dental Practice, Subiaco. This form is not a treatment plan or a quote.

DD/MM/YYYY

Do you have questions for the dentist before treatment?

Privacy: Example Dental Practice collects this information to provide your care. We may share it with the people who treat you. Read our privacy policy at example.com/privacy. Example only: the practice must write its own collection notice. See GEN-002.

Fields

  • Patient

    Name and date of birth.

  • Consent to treatment

    A tick. The dentist explains the treatment, its main risks and other options first. Consent can be withdrawn at any time.

  • Questions

    Yes or no. Tells the practice the patient wants to talk before treatment.

  • Health information

    A tick. The practice collects the health information on the form for care.

  • Collection notice

    A line the practice writes before anyone uses the form.

  • Signature

    Signed on the phone.

Questions

Does this form quote a price?

No. It covers consent only. Fees and treatment plans stay with your practice.

Is a signature on the phone enough?

nopen does not give legal advice on that. Ask your insurer or adviser if you need it confirmed for your profession.

About these templates

These templates are examples only, to help you get started. They are general information, not legal, medical, clinical or professional advice, and they may not suit your business, your profession or your state or territory.

Before you use any template, you must review and adapt it, and have it checked where needed, so it fits your services, your professional body's rules, privacy and health records laws, and the law where you operate. This matters most for consent, waiver, privacy and minors' forms. You are responsible for the forms you use and the information you collect.

To the extent the law allows, nopen gives no warranty that the templates are complete, current or fit for any purpose, and is not liable for loss arising from their use. Nothing here excludes, restricts or modifies any right or remedy you have under the Australian Consumer Law that cannot lawfully be excluded.

The templates are not endorsed by or connected with any government agency, including Services Australia, Medicare or the NDIA. Do not add government logos, the Commonwealth Coat of Arms or other official marks to them. Fields that refer to government numbers (such as a Medicare card number) are labels only.

Example only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. This example has not had a separate legal review.