dental solutions logo

235 South 400 East, Bountiful, Utah, 84010

(801) 298-1812

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

Schedule Your Consultation Today!

Appointments

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!

(801) 298-1812
Skip to content