All forms must be submitted in duplicate. Dentists must obtain informed consent for every treatment you propose and perform on patients or from the patient's legal guardian or decision-maker.I am provided with this refusal form and information so I may understand the recommended treatment and the consequences of refusing treatment. Dentist in Cuyahoga, OH - Visit our skilled Dentist in Cuyahoga, OH. Accepting new appointments. Call today or request an appointment online. You will receive a confirmation notification with a Request Number after successfully completing the form. Please allow up to five business days for processing. We may use PHI about you to provide you with health care treatment or services. For example, we may use your. General Dentistry Care Consent Form.