Digital Consent Forms

Total Templates
18
Organized by category
Active Templates
15
Ready to use
Draft Templates
3
In development
Forms Signed This Month
234
All categories
General Treatment Consent
Treatment Consent Active
Last Updated: Feb 10, 2025
Signed This Month: 45
Crown & Bridge Consent
Treatment Consent Active
Last Updated: Feb 8, 2025
Signed This Month: 32
Root Canal Therapy Consent
Treatment Consent Active
Last Updated: Jan 28, 2025
Signed This Month: 18
Extraction Consent
Treatment Consent Active
Last Updated: Feb 5, 2025
Signed This Month: 27
Implant Placement Consent
Treatment Consent Active
Last Updated: Feb 12, 2025
Signed This Month: 14
Orthodontic Treatment Agreement
Treatment Consent Active
Last Updated: Jan 30, 2025
Signed This Month: 12
Financial Responsibility Agreement
Financial Active
Last Updated: Feb 1, 2025
Signed This Month: 52
Payment Plan Agreement
Financial Active
Last Updated: Feb 3, 2025
Signed This Month: 28
Insurance Assignment of Benefits
Financial Active
Last Updated: Jan 25, 2025
Signed This Month: 41
Anesthesia Consent
Clinical Active
Last Updated: Feb 9, 2025
Signed This Month: 66
Nitrous Oxide Consent
Clinical Active
Last Updated: Feb 7, 2025
Signed This Month: 23
Radiograph Consent
Clinical Active
Last Updated: Jan 22, 2025
Signed This Month: 89
Bleaching/Whitening Consent
Clinical Active
Last Updated: Feb 11, 2025
Signed This Month: 19
HIPAA Privacy Notice Acknowledgment
Compliance Active
Last Updated: Jan 15, 2025
Signed This Month: 156
Patient Rights & Responsibilities
Compliance Active
Last Updated: Jan 18, 2025
Signed This Month: 98
Telehealth Consent
Compliance Active
Last Updated: Feb 6, 2025
Signed This Month: 34
Photography/Records Release
Compliance Active
Last Updated: Feb 2, 2025
Signed This Month: 12
Minor Patient Guardian Consent
Compliance Draft
Last Updated: Feb 13, 2025
Signed This Month: 0
Date Signed Patient Form Name Provider Signed By Method Status Actions
Feb 17, 2025 James Mitchell Crown & Bridge Consent Dr. Sarah Johnson Patient In-Office Signed
Feb 17, 2025 Jennifer Wang General Treatment Consent Dr. Michael Chen Patient Portal Signed
Feb 16, 2025 Robert Taylor Root Canal Therapy Consent Dr. Sarah Johnson Patient In-Office Signed
Feb 16, 2025 Maria Santos Financial Responsibility Agreement Dr. Lisa Rodriguez Patient Kiosk Signed
Feb 15, 2025 David Kim HIPAA Privacy Notice Acknowledgment Dr. Michael Chen Patient Portal Signed
Feb 15, 2025 Amanda Davis Implant Placement Consent Dr. Sarah Johnson Patient In-Office Partially Signed
Feb 14, 2025 Thomas Anderson Extraction Consent Dr. Lisa Rodriguez Patient In-Office Signed
Feb 14, 2025 Lisa Martinez Anesthesia Consent Dr. Michael Chen Patient Portal Signed
Feb 13, 2025 Christopher White Payment Plan Agreement Dr. Sarah Johnson Patient Kiosk Signed
Feb 13, 2025 Nicole Thompson Radiograph Consent Dr. Lisa Rodriguez Patient Portal Signed
Feb 12, 2025 Kevin Brown Insurance Assignment of Benefits Dr. Michael Chen Patient In-Office Signed
Feb 12, 2025 Patricia Lee Bleaching/Whitening Consent Dr. Sarah Johnson Patient Portal Signed
Feb 11, 2025 George Harris Telehealth Consent Dr. Lisa Rodriguez Patient In-Office Signed
Feb 11, 2025 Karen Wilson Patient Rights & Responsibilities Dr. Michael Chen Patient Kiosk Signed
Feb 10, 2025 Mark Johnson General Treatment Consent Dr. Sarah Johnson Patient Portal Signed
Feb 10, 2025 Barbara Jackson Nitrous Oxide Consent Dr. Lisa Rodriguez Patient In-Office Expired
Feb 9, 2025 Steven Moore Crown & Bridge Consent Dr. Michael Chen Patient Portal Signed
Feb 9, 2025 Susan Clark Financial Responsibility Agreement Dr. Sarah Johnson Guardian In-Office Signed
Feb 8, 2025 Edward Davis Root Canal Therapy Consent Dr. Lisa Rodriguez Patient Kiosk Voided
Compliance Metrics
Forms Completion Rate
98.2%
Average Time to Sign
2.4 min
Missing Consents
3
Missing Consent Alerts - Upcoming Procedures
Michael Torres - Root Canal (Tooth #14) - Procedure: Feb 20
Elizabeth Allen - Crown Prep (Tooth #8) - Procedure: Feb 21
Charles Patel - Extraction (Tooth #32) - Procedure: Feb 23
Create and customize consent form templates with drag-and-drop fields. Preview changes in real-time and configure auto-send rules.
Input Fields
Text Input
Paragraph
Date
Selection Fields
Checkbox
Radio Buttons
Signature Fields
Signature
Initials
Auto-Fill Fields
Patient Name
Provider Name
Procedure Details
Layout Elements
Section Header
Divider
Legal Text Block

General Treatment Consent Form (Draft)

v2.0 - Being edited

Section Header: Patient Information
Auto-Fill: Patient Name (Required)
Date: Today's Date (Required)
Section Header: Treatment Details
Auto-Fill: Procedure Name (Required)
Legal Text Block: Risks and Benefits
Divider
Section Header: Patient Acknowledgment
Checkbox: I understand the risks and benefits
Signature: Patient Signature (Required)
Section Header: Provider Attestation
Auto-Fill: Provider Name (Required)
This will create version 2.1 when saved
{{patient_name}} {{patient_dob}} {{provider_name}} {{procedure_name}} {{procedure_code}} {{tooth_number}} {{appointment_date}} {{practice_name}} {{practice_address}}