Patient Consent Forms

Most of the consent forms on this page are read-only. They will need to be signed and dated for the day of your procedure at the office. The Photo Release and Medical Records Release forms are the two exceptions that can be completed ahead of time if you choose to do so.

Feel free to contact us at (219) 836-4214 if you have any questions or concerns!

Request for Access to Medical/Dental Records

Photo and Video Testimonial Release Form

Prosthodontic Treatment Informed Consent

Extraction Consent

Botulinum (Botox) Consent

Implant Consent

Informed Consent for Implant Treatment

Consent for Dental/Oral Surgery Treatment in Patients Who Have Received Biophosphonate Drugs

Consent for the Use of Nitrous Oxide

Consent for Oral Surgery and Local Anesthesia

Consent for Sinus Lift Procedure

Consent for Sleep Disordered Breathing/Sleep Apnea Treatment