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ACE DNTL STUDIO

Aesthetic Dental Studio · Marbella · Estepona · Riviera · acedntl.com

Informed consent

Dental implant

Patient
Personal ID no.
ProcedureDental implant
Procedure date
Treating dentistDr. Arsalan Korkchi, licensed dentist
ClinicACE DNTL STUDIO, Marbella
Place and dateMarbella, 19 June 2026

This form confirms that the patient has been informed about the planned procedure and consents to it being carried out.

Procedure

The planned procedure is dental implant.

The procedure has been explained to the patient together with its purpose, how it is carried out and the result that can be expected. The patient has had the opportunity to ask questions and to have them answered.

Information & risks

The patient has been informed about the procedure (dental implant), its purpose and expected result, and about the following general risks:

  • Transient discomfort, swelling or tenderness in the area after the procedure.
  • Bleeding and a risk of infection, mitigated by good oral hygiene and any prescribed medication.
  • Temporary or, in rare cases, persisting altered sensation in the teeth, gums or lips.
  • Reaction to anaesthesia or prescribed medication.
  • That in individual cases the result may require adjustment or additional treatment.

Consent statement

I, the patient, confirm that I have been informed about the planned procedure, its purpose, expected result and the risks described above. I have been given the opportunity to ask questions and to have them answered in a way I understand. I consent to the treatment being carried out.

Signatures

Patient's signature and date
Dentist's signature and date

Dr. Arsalan Korkchi

Licensed dentist

ACE DNTL STUDIO, Marbella

Reg. no. / Nº colegiado

Clinic stamp

Marbella · España · acedntl.com

The consent is recorded in the patient's chart. A copy can be provided to the patient on request.