To be eligible to fill the Implant Consent Form, the following conditions should be met: The person should be 18 years old or more. If the person is below 18 years old, then he/she should take the permission of his/her parents or guardian. The person should be mentally fit and should be able to understand the pros and cons of the surgery. The person should not be suffering from any kind of mental illness. The person should not be under the influence of drugs or alcohol.
Patient Full Name
Date of Birth
Emergency Contact number
Please read the following information carefully and initial each section to indicate that you understand. I understand that the success of implants depends on many factors. These include the quality of my overall health, and whether I follow the instructions given to me by my doctor. I understand that even with the best of care, there is no guarantee that the implant will be successful.