---
title: Pediatric Dental Sedation Consent Form Template | Paperform
description: Comprehensive pediatric dental sedation consent form with health screening, NPO instructions, and emergency contacts. Ensure safe sedation procedures with proper documentation.
url: "https://paperform.co/templates/pediatric-dental-sedation-consent-form"
type: static
generatedAt: "2026-03-28T00:44:44.563Z"
---

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### Streamline Pediatric Dental Sedation Consent with Paperform

Managing pediatric dental sedation requires meticulous attention to patient safety, regulatory compliance, and clear communication with parents and guardians. This **Pediatric Dental Sedation Consent Form template** helps dental practices collect critical health information, document informed consent, and ensure NPO (Nothing by Mouth) guidelines are understood before sedation procedures.

#### Why Pediatric Dental Practices Need Digital Sedation Consent Forms

Traditional paper consent forms can be time-consuming, prone to illegibility, and difficult to store securely. When dealing with pediatric sedation—where proper health screening and parental understanding are paramount—digital forms offer significant advantages:

 - **Comprehensive health screening:** Capture detailed medical histories, current medications, allergies, and previous sedation experiences in a structured, easy-to-review format
 - **Clear NPO instructions:** Ensure parents understand fasting requirements with timestamped acknowledgment of guidelines
 - **Emergency preparedness:** Collect multiple emergency contacts and relevant medical provider information in one organized location
 - **Legal protection:** Document informed consent with eSignatures through Papersign integration, creating a complete audit trail
 - **Instant accessibility:** Store completed forms securely in your practice management system, accessible whenever needed during the procedure

#### How This Template Supports Your Dental Practice

This template is designed specifically for pediatric dentists, oral surgeons, and dental specialists who perform sedation procedures on children. It addresses the unique safety considerations of pediatric sedation, including:

**Pre-procedure health assessment:** The form collects comprehensive information about the child's medical history, including respiratory conditions, heart problems, previous adverse reactions to sedation, and current medications that might interact with sedation agents.

**NPO compliance verification:** Parents confirm their understanding of fasting requirements, document their child's last food and liquid intake, and acknowledge the risks of non-compliance—reducing the risk of aspiration during sedation.

**Multiple consent layers:** Beyond general treatment consent, the form specifically addresses sedation risks, potential complications, and alternative treatment options, ensuring truly informed consent.

**Emergency contact redundancy:** Capture primary and secondary emergency contacts, along with the family's preferred hospital and any relevant medical specialists who should be contacted in case of complications.

#### Customization for Your Practice's Sedation Protocols

Every dental practice has specific sedation protocols, and this template is fully customizable to match your procedures:

 - Add conditional logic to show different questions based on the type of sedation (minimal, moderate, deep, or general anesthesia)
 - Include your practice's specific NPO timing requirements for different age groups
 - Attach educational materials, pre-procedure instruction sheets, or post-operative care guidelines
 - Integrate with your practice management software like Dentrix, Eaglesoft, or Open Dental through Stepper workflows

#### Seamless Integration with Your Practice Workflow

Paperform makes it easy to incorporate this consent form into your existing workflow:

**Pre-appointment completion:** Send the form link to parents 24-48 hours before the scheduled sedation appointment, allowing them time to complete it at home without the stress of the waiting room.

**Staff review before procedure:** Completed forms automatically route to your sedation team for review, flagging any concerning medical history items that require follow-up.

**Automated follow-up:** Use Stepper (stepper.io) to automatically send pre-procedure reminders about NPO requirements, appointment times, and what to bring on the day of sedation.

**Post-procedure documentation:** Link sedation consent forms with your clinical notes and recovery monitoring records for comprehensive documentation.

#### Built for Safety, Compliance, and Peace of Mind

Pediatric sedation carries inherent risks, and proper documentation is essential for both patient safety and legal protection. This template helps you:

 - Meet state dental board requirements for sedation consent documentation
 - Comply with American Academy of Pediatric Dentistry (AAPD) sedation guidelines
 - Maintain organized records for quality improvement and peer review
 - Demonstrate due diligence in patient screening and informed consent processes

#### Security and Confidentiality

Patient health information requires the highest level of protection. Paperform is **SOC 2 Type II certified and GDPR compliant**, ensuring that sensitive pediatric medical information is encrypted and stored securely. Set up role-based access so only authorized clinical staff can view completed consent forms, and use data residency controls to ensure information stays within required jurisdictions.

*Note: While Paperform offers robust security features, it is not currently HIPAA compliant. Dental practices requiring HIPAA compliance should consult with their compliance officer regarding appropriate use.*

#### Get Started in Minutes

This template is ready to use immediately or can be customized to match your practice's specific protocols. The clean, mobile-friendly design ensures parents can complete the form on any device, and the clear language helps anxious parents understand exactly what they're consenting to for their child's procedure.

Whether you're a solo pediatric dentist or part of a multi-provider practice, this sedation consent form template provides the foundation for safer, more efficient sedation procedures. Combined with Paperform's payment integration (for collecting sedation fees), scheduling tools (for booking follow-up appointments), and Papersign (papersign.com) for secure eSignatures, you have everything needed to manage the complete sedation consent workflow.

Transform your pediatric sedation documentation from a paper-based hassle into a streamlined, secure digital process that prioritizes patient safety and parental understanding.
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