Division Family Dental

2484 NE Division St, Gresham Or 97030


Extraction Consent Form

Your dentist suggests that the following teeth be removed: For the following reason(s):
The consequences of not performing necessary extractions may include: Though rare, the following complications may occur during or after dental extractions:

I understand that tooth extraction is an elective procedure, and there are often alternative treatments, such as a root canal and restoration or performing no treatment at all. My dentist has described other options, invited me to ask questions, and I am electing to proceed with the extraction.

I will follow the verbal and written postoperative instructions and return for a follow-up appointment if requested.