Oral Surgery/ Extraction Consent Form

Please sign the form below to proceed with your treatment at Deva Dental Clinic

I have recommended that one or more of your teeth be extracted based upon your symptoms, my examination of your mouth, the treatment plan I have discussed with you and your choice.

Please take your time to read the information in this email. It is important that you understand the nature of the procedure we propose and its associated benefits and rare complications. If you have any questions please ask your dentist. If you are happy and agree with the following consent form, please sign this form stating your consent.