Consent Forms


After meeting with Dr. Pournik she will decide which treatment is best for you and answer any questions you might have. Once the treatment plan has been created and presented to you there may be additional consent forms you will need to complete. Below you will find these consent forms to complete.

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Note all of these forms are secure, encrypted and password protected. You will receive a copy of any signed form via email.

Cosmetic Treatment Consent #1
Cosmetic Treatment Consent #2
Nitrous Oxide Informed Consent Form
Extraction Consent Form
Composite Fillings Consent Form
Amalgam Replacement Procedures Consent Form
Endodontics (Root Canal Therapy) Consent Form
Crown & Bridge Prosthetics Consent Form
Dentures Consent Form
Dental Implants Consent Form
Scaling and Root Planing Consent Form
Photography Release
Authorization to Release Dental Records