CLINICAL FORMS CLINICAL FORMS Consent & Aftercare Forms 1. ENDODONTIC CONSENT FORM 2. EXTRACTIONS CONSENT FORM 3. SURGICAL EXTRACTIONS CONSENT FORM CONSENT FORMS • Help your patients to understand the reasons for and benefits of certain treatments • Confirm their intent for treatment with their signature, and retain a copy for your records • Choose from 2 different formats: 2-part carbonless, or bond paper • Color choices available on bond paper only • Sizes: 2-Part: 81⁄2"W x 11"H, Bond: 81⁄2"W x 11"H Item # 1. 367-1007 367-1008 2. 367-1004 367-1005 3. 367-1019 367-1020 4. 367-1010 367-1011 Description Endodontic Treatment Endodontic Treatment Extractions Extractions Surgical Extractions Surgical Extractions Restorations Restorations Format 2-Part Bond 2-Part Bond 2-Part Bond 2-Part Bond Lines 5 5 5 5 5 5 5 5 Price $40.29 $29.79 $40.29 $29.79 $40.29 $29.79 $40.29 $29.79 3@ $28.79 $19.49 $28.79 $19.49 $28.79 $19.49 $28.79 $19.49 5@ $27.79 $18.49 $27.79 $18.49 $27.79 $18.49 $27.79 $18.49 4. RESTORATIONS CONSENT FORM 1 Step Blue (B) Step Choose PAPER* White (W) Canary (C) *Bond Paper Items Only Green (G) Buff (Bu) Pink (P) 2 Choose TYPESTYLE Step 3 Choose TYPESTYLE 3000 3080 144 www.henryscheindental.com 3001 3081 3002 3087 3003 3004 3005 3083 319 8166http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671007%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671008%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671004%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671005%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671019%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671020%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671010%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671011%26CatalogName%3DDENTAL http://www.henryscheindental.com