Biopsy with Local Anesthesia Consent

    Informed Consent for Biopsy with Local Anesthesia

    My dentist has recommended that I undergo a biopsy of a lesion, which is a procedure in which a portion of the lesion or, all of the lesion will be removed. The expected result of this procedure is to adequately diagnose the lesion type.

    I understand that there are risks and complications associated with this procedure, which include, but are not limited to: infection, need for another biopsy to be performed, and scarring. In extreme cases, swelling, bruising and/or numbness of the face and tongue can occur. This can also be permanent.

    Understanding all of the above, I request that and hereby provide my informed consent to the treating doctor and his/her assistants to perform a biopsy. I understand that in the course of the biopsy it may become necessary to perform additional procedures, which, are not known to be needed at this time. I request that and hereby provide my consent to the doctor to perform such procedure at his/her discretion if needed during my biopsy.

    I consent to having local anesthesia. I understand that, the performance of diagnostic studies, relating to my biopsy, will be performed by other medical/dental professionals.

    I confirm with my signature that:

    • My dentist has discussed the above information with me.

    • I have had a chance to ask questions.

    • All of my questions have been answered to my satisfaction.

    • I do hereby consent to the treatment described in this form.

    Signature of Patient (or parent or legal guaridan):

    Relationship to Patient:


    Press the button below to submit the completed consent form.