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D R S I M O N G AU T H I E R
C E RT I F I E D P E R I O D O N T I ST CONSENT FORM:
EXTRACTION AND RIDGE PRESERVATION
Diagnosis. After a thorough examination of my dental condition, my periodontist
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To fill out a consent extraction form, follow these steps:
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Clearly state the duration for which the consent is applicable, highlighting any expiry dates or conditions.
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Make a copy of the filled-out form for your records and give a copy to the individual granting consent.
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In general, any entity that needs to ensure legal compliance and obtain permission to process personal data may require consent extraction.
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