Professional Scaling and Root Planing Consent Form Template

Dental practices providing periodontal treatments need clear, comprehensive consent documentation that protects both the practice and ensures patients fully understand their treatment plan. This Scaling and Root Planing Consent Form template is designed specifically for dental clinics, periodontists, and oral health professionals who perform deep cleaning procedures.

Why dental practices need this form

Scaling and root planing (SRP) is a non-surgical periodontal treatment that goes beyond routine cleanings. Because it involves deeper intervention, proper informed consent is essential—not just for legal protection, but to build patient trust and ensure treatment compliance. This form covers everything from treatment rationale and anesthesia options to post-procedure care and follow-up maintenance schedules.

What makes this template effective

Built with Paperform, this template allows your practice to collect detailed patient information, document informed consent, capture digital signatures, and schedule follow-up appointments—all in one seamless experience. Patients can complete the form on their own device in the waiting room or at home before their appointment, reducing paperwork and streamlining your intake process.

The form includes conditional logic that adjusts questions based on patient responses, ensuring relevant information is captured without overwhelming patients with unnecessary fields. For example, specific anesthesia preference questions appear based on patient comfort levels and previous experiences.

Perfect for dental and periodontal practices

Whether you're a general dentist offering periodontal services, a specialized periodontist, or part of a multi-location dental group, this template adapts to your workflow. Customize the medical history questions, add your practice branding, adjust consent language to match your protocols, and embed the form directly on your website or patient portal.

With Paperform's native integrations, submissions can flow directly into your practice management software, trigger appointment confirmation emails, or update patient records in your CRM. For practices looking to further automate their workflows, Stepper can help route completed consent forms to the appropriate staff, trigger insurance verification processes, or schedule automated pre-appointment reminders.

Secure, compliant patient data handling

While Paperform is not HIPAA compliant, it offers SOC 2 Type II compliance and strong security features suitable for many healthcare administrative workflows. For practices requiring HIPAA compliance, consider using this form for general consent and scheduling, while keeping protected health information in your certified systems.

Streamline periodontal treatment workflows

This template helps dental practices reduce administrative burden, improve patient communication, and maintain thorough documentation of consent for periodontal procedures. With Papersign integration, you can even turn completed forms into formal treatment agreements that require additional signatures from multiple parties if needed.

Get started with this template today and create a smoother, more professional experience for patients undergoing scaling and root planing procedures.