Crown and Bridge Consent

About this form

The crown and bridge consent is a consent forms document used by dental practices. Consent for crown or bridge restoration including preparation and temporary care. In BoomCloud Forms it is a starting point: every field, heading and statement can be edited before you share it with patients.

Practices may use this template as a starting point and should review the wording against their own professional, regulatory and legal requirements before use.

What's included

This template ships with 9 fields:

• Patient Name — Text
• Tooth/Teeth Number(s) — Text
• Restoration Type — Single choice
• I understand tooth preparation is irreversible — Multiple choice
• I understand a temporary restoration will be placed — Multiple choice
• I understand sensitivity may occur — Multiple choice
• I understand shade matching may not be exact — Multiple choice
• Patient Signature — Signature
• Date — Date

When practices use it

Dental teams typically attach this form to the treatment workflow, completing it with the patient after the procedure and its alternatives have been discussed. It can be sent digitally ahead of the visit, completed on a tablet in the office, or printed as a PDF.

How to customize it

• Reword any question, add fields, or remove ones your practice doesn't need.
• Apply your practice name, logo and colors so the form matches your brand.
• Switch to another supported language where a translated version exists.
• Share a secure link with the patient, or download a print-ready PDF.