The Consent Form For Dental Treatment is a critical document required under Dutch healthcare law, particularly the Medical Treatment Contracts Act (WGBO). It should be used before performing any significant dental procedure to ensure patients are fully informed about their treatment and have given explicit consent. The document serves multiple purposes: it fulfills legal requirements for informed consent, provides clear documentation of the treatment plan and associated risks, protects both the dental practice and patient interests, and ensures compliance with Dutch healthcare regulations and privacy laws. The form is particularly important in cases involving complex procedures, significant risks, or substantial costs. It should be regularly updated to reflect current legal requirements and professional standards set by the Dutch Dental Association (KNMT).

1. Patient Information: Patient's personal details including name, date of birth, contact information, and patient ID number

2. Dental Practice Information: Details of the dental practice, treating dentist, and contact information

3. Treatment Information: Detailed description of the proposed dental treatment(s), including purpose and expected outcomes

4. Risks and Complications: Overview of potential risks, side effects, and complications associated with the treatment

5. Alternative Treatments: Description of available alternative treatment options and consequences of no treatment

6. Post-Treatment Care: Instructions for after-care and follow-up appointments

7. Costs and Insurance: Information about treatment costs, insurance coverage, and payment arrangements

8. Patient Rights: Statement of patient rights including right to withdraw consent and request information

9. Privacy Statement: Information about how patient data will be handled in accordance with GDPR/AVG

10. Declaration of Consent: Explicit statement of consent and signatures of patient (or legal representative) and dentist