Dentists must obtain informed consent for every treatment you propose and perform on patients or from the patient's legal guardian or decision-maker. Find sample forms and letters to support documentation, employment, general liability and patient care.Search Sample Forms. A signed informed refusal form does not exonerate a dentist from liability, as dentists are obligated to practice at a certain standard of care. Dental consent and refusal forms should be saved as part of the patient's record in the same manner you document other patient information. I authorize the dental staff to perform any necessary dental services that I may need during diagnosis and treatment, with my informed consent. Signature. A full refund will be given in the original form of payment if merchandise is returned within 14 days of purchase with the original receipt and in the. PA is a request for a service from your doctor. Your PCP will help you to get PA if it is necessary. I understand that no dental treatment is completely risk free and that my dentist would take reasonable steps to limit any complications of my treatment.