About this template
A teledentistry consent form is essential for dental practices offering virtual consultations, triage, or remote treatment planning. This form ensures that patients fully understand the nature, benefits, risks, and limitations of receiving dental care remotely before their virtual appointment begins.
Using Doc2Form, dental clinics can quickly deploy this consent template to gather patient details, verify adult status or guardian authorization, and secure clear acknowledgment of virtual care terms. Collecting these agreements digitally streamlines your pre-appointment workflow, reduces administrative friction, and ensures that patients are properly informed before logging onto their video consultation.
Whether your practice is expanding into virtual triage or offering routine remote follow-ups, this structured template keeps your onboarding process smooth, professional, and well-documented.
Key features
- Collect informed consent for virtual dental visits prior to appointments.
- Verify patient identity, contact information, and adult status instantly.
- Include parent or guardian signature sections for minor patients.
- Easily shareable via email link or embedded directly on your practice website.
- Streamline administrative pre-appointment workflows with zero paperwork.
Use cases
- Remote dental triage and initial virtual consultations.
- Post-operative check-ins and follow-up care assessments.
- Teledentistry appointments for orthodontic progress evaluations.
What this form collects
- Patient Full Name (Short answer)Enter your first and last name as it appears on your ID.
- Phone Number (Short answer)Enter the best phone number to reach you for your virtual appointment.
- Email Address (Short answer)We will send your virtual meeting link and appointment confirmation here.
- Are you signing on behalf of a minor? (Multiple choice)Select yes if you are a parent or legal guardian filling this out for a patient under 18.
- Parent or Guardian Name (Short answer)If signing for a minor, please enter your full name here.
- Acknowledgment of Teledentistry Terms (Checkboxes)Teledentistry involves the use of electronic communications to enable healthcare providers at different locations to share individual patient clinical information. By checking below, you acknowledge understanding of the risks, limitations, and benefits of virtual care.
- Patient or Guardian Signature (Short answer)Please type your full legal name to serve as your digital signature.
- Date of Signature (Date)Select today's date.
FAQ
What is a teledentistry consent form?
It is a digital document used by dental practices to inform patients about the nature of virtual care and to collect their formal agreement and signature before a remote appointment.
Why is virtual care consent necessary?
It ensures patients understand the technological limitations, potential privacy risks, and clinical scope of remote dental appointments before care is delivered.
Can parents or guardians sign on behalf of minor patients?
Yes, this template includes dedicated fields to capture the name and signature of a parent or legal guardian when the patient is a minor.
How do patients access and complete the form?
You can send patients a direct link via email or text message prior to their scheduled virtual visit so they can review the terms and submit their details from any device.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.