Abstract Objectives The purpose of this report is to highlight the need of obtaining a valid informed consent from patients undergoing dental hygiene procedures and the responsibilities and obligations of the hygienist in such context. Materials and methods Building on the existing informed consent forms used for dental procedures, the authors have developed treatment-specific forms geared to the needs of the dental hygienist. They include 4 sections: 1) patient data; 2) clinical history; 3) information on the treatment being proposed by the doctor/dentist, techniques and/or materials that will be used in the treatment, contraindications to such treatment, the results that can be obtained, and instructions for post-procedure care to avoid complications; 4) a statement to be signed by the patient and dental hygienist in which the former affirms that he/she received the information listed above and that he/she accepts or refuses to undergo the proposed treatment. Results The proposed form can be very useful to dental hygienists attempting to implement current regulations regarding patient information and consent to treatment. Conclusions The signed form must be saved since it constitutes evidence that may prove relevant in any lawsuits either arising over unsuccessful treatment or other claims filed by the patient.