Wisdom Teeth Extraction Consent

About this form

The wisdom teeth extraction consent is a consent forms document used by dental practices. Specific consent for third molar extraction including nerve risk and dry socket information. 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
• I consent to extraction of third molars — Multiple choice
• I understand risks including nerve damage and dry socket — Multiple choice
• I understand swelling and bruising may occur — Multiple choice
• Anesthesia Type — Single choice
• I have a responsible adult to drive me home — Multiple choice
• I have followed pre-operative fasting instructions — Multiple choice
• Current Medications — Long answer
• 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.