Get Informed Refusal Template

This guide provides a detailed overview of how to fill out the Informed Refusal Template online, ensuring users can effectively communicate their treatment decisions. By following these steps, individuals can complete the form accurately and confidently.

Follow the steps to complete the Informed Refusal Template online.

1. Click the ‘Get Form’ button to access the Informed Refusal Template and open it in your chosen online editor.
2. Begin by entering the patient's name in the designated fields for last name and first name.
3. Input the date of birth in the specified format to ensure proper identification.
4. In the section regarding the nature of the recommended treatment, provide a clear description of the proposed treatment.
5. For the necessary treatments, check the appropriate options that apply, such as decay, broken tooth/teeth, infection, or other relevant conditions.
6. Describe the intended benefits of the treatment to offer clarity about the rationale behind the procedure.
7. Fill in the estimated number of visits required to complete the treatment as well as the associated costs.
8. In the alternative treatments section, list any other options available, including a note if no other reasonable treatments exist.
9. Detail any discussions about risks associated with both the recommended treatment and the risks of not proceeding with it.
10. Finally, acknowledge receipt of the information regarding treatment by signing and dating the form as the patient or guardian, as well as securing signatures from the treating dentist and a witness.

Start filling out your Informed Refusal Template online now.