Consent for Oral Sedation

Triazolam/Ambien is a medication that can greatly minimize anxiety that may be associated with going to the dentist. Even though it is safe and effective, you should be aware of some important precautions and considerations.

• Please take one tablet one hour prior to your appointment and bring the other tablet with you. You will be directed as to when to take the next tablet.
• Triazolam/Ambien will cause you to become drowsy. You will need a driver to and from your appointment.
• We request you walk in with your driver and that they stay for the remainder of your appointment.
• We will go through homecare with your driver to reiterate any specific details. Please also review your homecare instructions provided to you on the day of your consultation.
• We recommend that you have a caretaker to stay with you the remainder of the day.
• Please avoid alcohol, sedatives, and sleeping pills for the remainder of the day.
• You should not drive or operate machinery for the remainder of the day.
• There are no guarantees regarding the outcome or effectiveness of oral sedation.

By signing below, I certify that I have read and fully understand this consent form. I have had the opportunity to ask questions, and all questions were answered to my satisfaction. I consent to oral sedation for my dental procedure.