CBCT SCAN CONSENT FORM

Give your dental practice a professional, comprehensive consent form for Cone Beam Computed Tomography (CBCT) imaging. This customizable template helps document patient understanding of the purpose of CBCT, radiation exposure, pregnancy considerations, procedure expectations, image limitations, potential incidental findings, and the possibility of additional diagnostic imaging.

What's Included:

• Professional CBCT consent form

• Patient and procedure information

• Radiation exposure acknowledgement

• Pregnancy / possible pregnancy section

• Patient movement and image-quality considerations

• CBCT-specific risks and limitations

• Unexpected and incidental findings section

• Additional imaging considerations

• Alternatives section

• Patient acknowledgement and consent

• Dentist/provider acknowledgement

• Professional Willow & Pine formatting

• Fully customizable for individual dental practices

Please Note: This is a template resource and does not constitute legal, regulatory, or clinical advice. Dental practices are responsible for reviewing, customizing, and ensuring the document is appropriate for their practice and complies with applicable requirements before use.