Copy this consent form template 👉
CONSENT FOR ORTHODONTIC TREATMENT
Patient Information:
Name: __________________________________________
Date of Birth: _____________________________________
Consent for Dental Treatment
I, the undersigned, hereby give consent to Dr. ___________________________ to perform Orthodontic Treatment on: ______________________________________ (“Treatment”) on me or my dependent. I understand that unforeseen conditions may arise during the procedure that could necessitate additional or alternative treatments, and I authorize such procedures as deemed necessary by my dentist.
I acknowledge that the nature, purpose, and expected outcomes of the recommended Treatment have been explained to me. I understand that no guarantees or promises have been made regarding the final results.
Alternatives to Treatment
I have been informed about alternatives to the recommended Treatment, including Invisalign, other orthodontic appliances, or no treatment. I understand the potential consequences of choosing not to proceed, such as continued misalignment, bite issues, or other functional and aesthetic concerns.
Potential Risks and Complications Related to Orthodontic Treatment
I understand that orthodontic treatment carries certain risks and complications, which may include, but are not limited to:
Acknowledgment and Consent
I confirm that:
By signing below, I consent to the performance of the Treatment as described above.
Signature:
Patient/Parent/Guardian: _____________________________________
Date: ________________________________
Relationship (if signing for a minor): ___________________________________
A comprehensive orthodontic consent form is essential for both legal protection and ensuring patients fully understand their treatment. As orthodontic procedures involve long-term commitment and potential risks, proper documentation is crucial for dental practices in 2025.
The orthodontic consent form should clearly outline the following key elements:
This initial section captures basic identifying information about the patient. For minors, include fields for parent/guardian information as they will be the consenting party.
Clearly explain the specific orthodontic treatment being proposed. Whether traditional braces, clear aligners, or other appliances, patients need to understand what they're consenting to.
Ethical consent requires informing patients about all viable treatment alternatives. This section should outline other options like Invisalign, different bracket systems, or the consequences of no treatment.
The 2025 standard for orthodontic risk disclosure has become more detailed. Include common risks like discomfort and potential complications such as root resorption, decalcification, and the possibility of treatment taking longer than initially estimated.
Set realistic expectations about retainer wear and the potential for relapse if retention protocols aren't followed. This has become especially important as research continues to emphasize the lifelong nature of retention.
Implementing this template into your practice workflow is straightforward. Simply click the 'copy' button from the template section above and paste it into your preferred text editor or practice management software.
After copying the template, customize it to reflect your specific practice policies and the individual patient's treatment plan. Remember to:
Add your practice letterhead and contact information
Modify language to match your specific orthodontic procedures
Review with your legal counsel to ensure compliance with your state's dental regulations
Consider translating the form for non-English speaking patients
The consent discussion should always happen face-to-face, allowing patients to ask questions before signing. Document this conversation in the patient's chart as additional protection.
For electronic implementation, ensure your digital consent process complies with HIPAA guidelines and includes proper authentication measures for the signing parties.
Managing consent forms is just one aspect of the extensive documentation required in orthodontic practice. The clinical notes that accompany each patient visit can be equally time-consuming to produce.
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Denota works seamlessly with your existing practice management software – simply open it alongside your current system, much like using a Google Doc, but with the power to automatically generate professional clinical documentation.
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*Disclaimer: This document is a sample form provided by Denota and should not be considered medical or legal advice. Because the details of your situation may vary, and the laws in your jurisdiction may differ, you are advised to consult your attorney or other qualified professionals if you have any questions related to legal or medical responsibilities, state or federal laws, contract interpretation, or any other legal matters.
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