Treatment Consent Form Dental
Description
How to fill out West Virginia Voluntary Treatment Agreement?
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FAQ
Write directly to the reader, as though you are explaining the facts in person. Informed consent language should be written in the second person (?you?), not in the first person (?I?). Minimize passive voice to the extent possible.
I (patient name) give permission for [practice name] to give me medical treatment. I allow [practice name] to file for insurance benefits to pay for the care I receive. I understand that: [practice name] will have to send my medical record information to my insurance company.
Consent to Participate I have been encouraged to ask questions and all of my questions have been answered to my satisfaction. I have also been informed that I can withdraw from the study at any time. By signing this form, I voluntarily agree to participate in this study.
In its most basic terms, informed consent is the conversation during which the dentist gives the patient information about: Any dental health problems that the dentist observed. The nature of any proposed treatment. The potential benefits and risks associated with that treatment. Any alternatives to the proposed ...
I acknowledge that no guarantee or assurance has been made by anyone regarding the dental treatment which I have requested and authorized. I have had the opportunity to read this form and ask questions. My questions have been answered to my satisfaction. I consent to the proposed treatment.