Home / New Patients / Patient Forms / IVC Consent
IVC Consent

Schedule Your Consultation Today!

Ask the doctor

 IV Vitamin C Consent

  • IV Vitamin C Informed Consent

  • Vitamin C aids in the regeneration of oral tissues, and has been recommended by Dr. Wall to aid in your oral rehabilitation. Numerous studies have shown the benefits of vitamin C in fighting periodontal disease (gum disease), gingivitis, promoting bone and teeth health, and improving general oral immune health.M

    I understand that this procedure is not considered "routine and customary." However, I feel that it may be beneficial in my particular case, and I give my consent to the administration of IV vitamin C.

    Patients who have the following conditions should NOT have IV vitamin C:

    • Uncontrolled diabetes

    • Kidney disease or nephritic syndrome

    • Reduced kidney function

    • Urinary tract infection

    • History of anemia due to G-6-PD deficiency

  • MM slash DD slash YYYY

After submitting, feel free to return to the Patient Forms page. Please note, there are multiple forms for each section.

Schedule Your Consultation Today!

Skip to content