Forms

Please print these forms and create Patient Packets for each pre-operative appointment.  Specific instructions for each form are given below.  All patient forms must be signed before a surgery is scheduled and prescriptions are given.

 

Pre-Operative Instructions

Have patient read and sign this form, then make a photocopy for them to take home.

 

Post-Operative Instructions

Have patient take this form home.

 

Medical History

Have patient fill out and sign.  Scan or take a photo and email to Dr. Johnson for evaluation.

 

I.V. Consent

Have patient read and sign.

 

Surgical Consent

Have patient read and sign.

 

Sedation Record

Fill out top two lines (disregard SPO2 if office does not have pulse oximeter).

 
All forms with the exception of the post-operative instructions should be kept as a packet and presented to Dr. Johnson at the surgery appointment.

Program Manual

Terrified and anxious were the emotions I felt prior to having my dental procedure. Nevertheless, the experience I received at Bourland-Soben Dentistry far exceeded my expectations and I highly recommend them. The staff was courteous and made me feel at ease. Dr. Johnson’s professionalism, knowledge and attentiveness turned a frightening experience into a pleasant and memorable one. My mouth cannot thank you enough.

- Sidd