Pediatric Dental Sedation Consent Form

Safe Pediatric Dental Sedation Made Simple

When your dental practice provides sedation services for young patients, clear communication and thorough consent documentation aren't just best practice—they're essential for patient safety and risk management. This Pediatric Dental Sedation Consent Form template gives you a professional, comprehensive solution that covers all the critical elements of informed consent while remaining accessible to parents and guardians.

Why This Template Works for Pediatric Dental Practices

Dental sedation for children requires meticulous preparation and clear communication with parents. This template walks families through fasting requirements, explains monitoring procedures in plain language, outlines what to expect during recovery, and captures essential medical history that affects sedation safety. Instead of juggling paper forms, phone calls, and follow-up emails, you'll collect everything you need in one organized submission.

The form uses conditional logic to adapt based on the sedation level being used—minimal, moderate, or deep sedation—ensuring parents receive information relevant to their child's specific procedure. Questions automatically adjust to capture age-appropriate details, and parents can indicate their preference for staying with their child during induction and recovery.

Built for Dental Professionals Who Care About Safety and Compliance

Pediatric dentists, oral surgeons, and dental practices offering sedation services will find this template captures all necessary consent elements while maintaining a reassuring, family-friendly tone. The form covers:

• Complete medical history including allergies, current medications, and previous sedation experiences
• Fasting compliance confirmation with clear pre-operative instructions
• Sedation type and procedure explanation with risk disclosures
• Monitoring and safety protocols that will be followed
• Recovery expectations and post-operative care instructions
• Emergency contact information and parent/guardian authorization
• HIPAA acknowledgment and consent to treat

You can customize the medical questions, add your practice's specific protocols, adjust the risk disclosures to match your procedures, and even integrate with Papersign to collect legally binding eSignatures from parents and guardians. Once submitted, connect the form to your practice management system, send confirmations via email, and use Stepper to automatically trigger pre-appointment reminders about fasting requirements or follow-up calls to check on recovery.

Designed for Trust and Clarity

Parents entrusting you with their child's care need to feel confident and informed. This template balances thoroughness with readability, using clear headings, helpful descriptions, and a warm visual design that reduces anxiety. The form works beautifully on mobile devices, so parents can complete it from anywhere, and all submissions are stored securely with SOC 2 Type II compliance.

Whether you're a solo pediatric dentist or part of a multi-location practice, Paperform gives you the tools to deliver professional, compliant consent forms that put families at ease while protecting your practice.