Informed Consent Samples | MedPro Group Dental

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Informed Consent Samples

Our sample forms can help you and your practice with informed consent — a key part of the provider/patient conversation prior to any treatment.

Anesthesia
Apicoectomy
Biopsy
Bone Grafting
Composite Restoration
Cosmetic Dentistry
Crown and Bridge Prosthetics
Dental Implants
Endodontic Procedures
Exposure of Teeth
Implant Placement
Implant-Supported Prosthetics
Minimal Oral Sedation
Nitrous Oxide and Oxygen Conscious
Oral Surgery (General)
Orthodontic Treatment
Orthognathic Surgery
Periodontal Treatment
Scaling and Root Planing
Tooth Extraction

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All data is derived from MedPro Group records and calculations; claims data range is 2015-2024 unless otherwise indicated.

For latest AM Best rating, access ambest.com. 7/18/2025

MedPro Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company, PLICO, Inc. and MedPro RRG Risk Retention Group. All insurance products are administered by MedPro Group and underwritten by these and other Berkshire Hathaway affiliates, including National Fire & Marine Insurance Company. Product availability is based upon business and/or regulatory approval and may differ among companies. © MedPro Group Inc. All Rights Reserved.

Product availability is based upon business and/or regulatory approval. In order to qualify for a free tail, you must have a retroactive date at least 48 months prior to the date of retirement and be insured by the company for 12 months on a mature Claims-made policy.

†Must qualify for both new-to-practice and new-to-company credits for $50 policy.

Dental Advisory Board Member

Shafa Nathani DMD

Dr. Shafa Nathani received her Bachelor’s degree in Cell & Molecular Biology with a minor in Public Health from the University of South Florida. She continued her education at the same institution, earning a Master of Science degree with a concentration in Anatomy. Dr. Nathani then pursued her Doctor of Dental Medicine (DMD) at Tufts University School of Dental Medicine in Boston, Massachusetts.

Throughout her dental education, Dr. Nathani held multiple leadership positions, the most distinguished being her service as the 2023–2024 National President of the American Student Dental Association (ASDA). In this role, she represented over 20,000 dental students nationwide, collaborated with dental organizations and policy leaders, and worked to advance the future of dentistry through advocacy, education, and leadership development.

She graduated in May 2024, recognized for her clinical excellence and deep understanding of organized dentistry. In addition to her practice, Dr. Nathani has served on the MedPro Advisory Board since 2024, where she and her fellow board members review claims, evaluate emerging risks, and provide insight into the evolving landscape of dentistry.

Today, Dr. Nathani practices as a general dentist at an Ideal Dental office in Dallas, Texas. She is committed to creating a welcoming environment for her patients, empowering them through education, and giving back to the community through outreach and service.

Dental Advisory Board Member

Mario Catalano, DDS

Dr. Catalano graduated from the SUNY at Buffalo School of Dental Medicine in 1967 and spent two years in the U.S. Navy before beginning his private practice in Catskill, NY, where he still practices today. He has been very involved in organized dentistry and has held positions including chairman of the New York State Political Action Committee, chairman of the American Dental Political Action Committee, and President of the New York State Dental Association. Today, he is focused on running his dental practice, defending dentists as an expert witness in malpractice trials, and lecturing younger dentists on malpractice issues and risk management.

Dental Advisory Board Member

Marc Leffler, DDS, ESQ

Dr. Leffler received his D.D.S. degree from Columbia University in 1982, after which he completed residency training in oral and maxillofacial surgery at Bellevue Hospital Center/New York University, subsequently becoming board-certified in oral and maxillofacial surgery. He practiced oral surgery in both office and academic settings, supervising the training of residents and dental students in out-patient anesthesia, orthognathic surgery, dentoalveolar surgery, and emergency management of medically compromised patients. Dr. Leffler then received his law degree from New York Law School and practiced trial law in New York, having represented dentists and dental specialists in dental malpractice litigation, dental board disciplinary actions, and peer review proceedings. He is currently a dental and oral and maxillofacial surgery consultant for MedPro. Outside of professional activities, he serves as a United States Coast Guard Auxiliary Flotilla Commander and as a marathon guide runner for disabled athletes who are members of Achilles International, for which he also sits on the Board of Directors of its New Jersey Chapter.

Dental Advisory Board Member

Leon “Stan” Stanislav, DDS

Dr. Stanislav graduated from the University of Iowa School of Dentistry in 1977. He spent two years in the U.S. Navy Dental Corps prior to beginning private practice in Clarksville, TN, where he still practices today. Throughout his career, Dr. Stanislav has been very involved in organized dentistry. He is a past president of the Tennessee Dental Association (TDA), the TDA Council on Insurance, and the Tennessee Academy of General Dentistry.

Dental Advisory Board Member

Robert A. Strauss, DDS, MD

Dr. Strauss graduated from the University of Buffalo School of Dentistry in 1979. He acquired his residency experience in anesthesiology and oral and maxillofacial surgery at the Michael Reese Medical Center in Chicago. He has a background in academics and private practice and has served as the professor and director of the oral and maxillofacial surgery residency training program at Virginia Commonwealth University/MCV Hospitals in Richmond, VA since 1987. Among his involvement in many professional associations, he is a past president of the American College of Oral and Maxillofacial Surgeons, a past president of the Virginia Society of Oral and Maxillofacial Surgeons, an Examiner with the American Board of Oral and Maxillofacial Surgery and a fellow of the American College of Oral and Maxillofacial Surgeons, the American Association of Oral and Maxillofacial Surgeons, and the American College of Surgeons.

Dental Advisory Board Member

Tara Aboumahboub, DMD

Dr. Tara Aboumahboub was born and raised in South Florida. She received her Bachelor’s degree in biotechnology and minor in nutrition from the University of Florida. Prior to dental school, she spent several years in the immunology lab at the University of Florida College of Dentistry. She then completed her dental training in Boston at Tufts University School of Dental Medicine, having achieved the highest level of clinical competency and success.

During her training, Dr. Tara treated patients with a multitude of backgrounds and medical complexities. She travelled and trained internationally, where she developed a deep understanding of healthcare disparities and recognized the opportunity to provide care for a community. She brings that same passion to her every day care here in the U.S. She attributes her keen eye for perfection to her artistic and aesthetic background. She prioritizes making connections with every patient that sits in her chair. Dr. Tara strives to advocate for and educate patients as well as practice evidence-based dentistry.

Today, Dr. Tara is caring for patients in private practice as a general dentist in Cincinnati, OH and runs her social media page, Dentara, to help patients build confidence in their smile and overall health. She is also a member of the Ohio Dental Society and proudly a constituent of the IgniteDDS family. Dr. Tara continues to grow professionally and personally as she navigates the various opportunities the dental field has graciously brought forth.

Dental Advisory Board Member

Austin Harbison

Austin is a fourth year dental student at the Adams School of Dentistry at the University of North Carolina at Chapel Hill and one of MedPro Group’s ASDA Student Liaisons. Before dental school, Austin attended Appalachian State University where he earned his Bachelor of Science in Biology and his Master of Science in Biology. Austin worked in student affairs through grad school and for a year post graduation before matriculating into dental school. Austin has also served as the UNC ASDA chapter’s co-president, LGBdenT Vice President, Pride Clinic Coordinator and Give Kids a Smile Co-chair. Looking forward, Austin hopes to find a job where he can blend his passion for social justice, community involvement and oral health education.

Dental Advisory Board Member

Navtinder Dhillon

Navi is a fourth-year dental student at the University of California, San Francisco and one of MedPro Group’s ASDA Student Liaisons. Navi is from Modesto, California, and attended University of California, Davis where he earned his Bachelor of Science in Biological Sciences. He enjoys roles that allow him to have a visible impact on the community, like being a student coordinator of the UCSF Community free dental clinic for underserved people of the Bay Area and serving as the Professional Development Chairman for his ASDA Chapter. He hopes to use his passion for community activism to help address socioeconomic healthcare disparities in rural communities like his home Central Valley.