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

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Download document instead

Photo and Video Testimonial Release Form

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Download document instead

Prosthodontic Treatment Informed Consent

Download

Extraction Consent

Download

Botulinum (Botox) Consent

Download

Implant Consent

Download

Informed Consent for Implant Treatment

Download

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

Download

Consent for the Use of Nitrous Oxide

Download

Consent for Oral Surgery and Local Anesthesia

Download

Consent for Sinus Lift Procedure

Download

Consent for Sleep Disordered Breathing/Sleep Apnea Treatment

Download