Sedation Dentistry Consent

About this form

The sedation dentistry consent is a consent forms document used by dental practices. Conscious sedation consent covering pre-operative instructions and escort requirements. 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 10 fields:

• Patient Name — Text
• Sedation Type — Single choice
• I have followed pre-operative fasting instructions — Multiple choice
• I understand the risks of sedation — Multiple choice
• I have a responsible adult to accompany me — Multiple choice
• Escort Name and Phone — Text
• Current Medications — Long answer
• I will not drive or operate machinery for 24 hours — 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.