CONSENT FOR EXTRACTION OF TEETH
Extraction of teeth is an irreversible process and, whether routine or difficult, is a surgical procedure. As in any surgery, there are some risks. They include, but are not limited to:
Most procedures are routine, and serious complications are not expected. Those which do occur, are most often minor and can be treated.
Teeth to be extracted: ______________________________________________________
I have read and understand the above, and had my questions answered. I recognize there can be no warranty as to the outcome of the treatment, and I give my consent to surgery.
|Patient's Signature (or Legal Guardian)||Date|