Consent For Endodontic Therapy
And such other additional or alternative procedures that may be found immediately necessary during the course of treatment. I also consent to the use of local anesthetics and/or sedation for the purpose of this treatment.

I understand the goals of endodontic root canal treatment is to retain that may otherwise require extraction. Although endodontic root cancel treatment usually has a high degree of clinical success, it is a dental-biological procedure, whose results cannot be guaranteed. Occasionally, endodontic root canal treatment may fail, resulting in tooth loss. A permanent (outside) restoration, such as a crown only or full-coverage crown should be placed afterward. Following the completion of endodontic root canal treatment, fracture and loss of my roots canal-filled tooth due to brittleness may be more likely to occur unless my root canal-filled tooth is restored within a month following completion endodontics.

POSSIBLE COMPLICATIONS which have been discussed with me include, but are not limited to:
1. Pain and swelling
2. Injury to the nerves of the lower lip, teeth, chin, and tongue causing numbness and or pain which could be permanent
3. Infection
4. Unusual reactions to medications given or prescribed
5. Separation of instrumentation in the root canal
6. Tooth fracture, root perforation, sinus perforation
7. Antibiotics may inhibit the effectiveness of birth control pills

I acknowledge that no guarantee or assurance has been made to me as to the results that may be obtained. I agree to cooperate completely and will follow post-operative instructions to the best of my ability for my own comfort and safety. I have had the opportunity to ask questions concerning these procedures and all my questions have been answered.


Check Us Out on Social Media

Book Now

Your First Name
Field is required!
Your Last Name
Field is required!
Your Email Address
Field is required!
Your Phone Number
Field is required!
  • Preferred time slot
  • 9 a.m - 10 a.m
  • 10 a.m - 11 a.m
  • 11 a.m - 12 p.m
  • 12 p.m - 1 p.m
  • 1 p.m - 2 p.m
  • 2 p.m - 3 p.m
  • 3 p.m - 4 p.m
  • 4 p.m - 5 p.m
  • 5 p.m - 6 p.m
  • 6 p.m - 7 p.m
Preferred time slot
Field is required!
  • Preferred day
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
Preferred day
Field is required!
Reason for visit
Field is required!

Patient Reviews

Awesome company
Image is not available
Carina Barros

Awesome company and super friendly staff!

Very good team!
Image is not available
Breanna Thorn

I went to Stroud dental on monday for the first time in 13 years..... I was so afraid to go. The experience was amazing. They made me feel comfortable. Jess is very good at her job and gentle. I didnt feel embarrassed or shamed at all. They made sure I got my x Ray's up to date and informed me, my old x Ray's had baby teeth in them. Very good team! Happy I went in and faced my fears.

We highly recommend Stroud Dental!
Image is not available
Shawna Toole

My husband is terrified of going to the dentist and after convincing him to go to Stroud Dental for the first time he has now been 3 times! The staff is absolutely amazing and made him feel safe and comfortable! He actually looks forward to going to the dentist now. Dr. Peleg rocks and the girls are a hoot. We highly recommend Stroud Dental!

The best experience I have ever had!
Image is not available
Cassandra Dickson

Stroud dental was the best experience I have ever had! The staff are very knowledgeable and friendly, it was very clean, fast and efficient. thank you for making my smile beautiful! I would highly recommend this dental office.

A wonderful place to bring your children.
Image is not available
Logan Beau

Stroud Dental is a wonderful place to bring your children. The staff are amazing with my sons, one of which is on the autism spectrum. They are patient and understanding of his quirks. If you’re looking for a great place for dental work check out Stroud Dental.

We couldn’t be more happy.
Image is not available
Keith Shay Smeets

We have been patients of Stroud Dental for over five years!
They have the most amazing team, who make you feel comfortable, welcomed and part of their family!
They are so patient with our 15 month old daughter, and us!
We couldn’t be more happy with everyone at Stroud Dental!

Family, friendly!
Image is not available
Dana Donaldson

Family, friendly! Have always been great with my kids. Always a pleasant experience.

previous arrow
next arrow

Get In Touch With Us