knowingly and willingly consent to have dental treatment completed during the COVID-19 pandemic.
I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms but will still be highly contagious. It is not always possible to determine who has it and who does not given the current limits in virus testing.
Dental procedures create water spray which is one of the ways the disease may spread. The ultra-fine nature of the spray can linger in the air for some time, which can possibly transmit the COVID-19 virus.
Do you have or have you had any of the following symptoms of COVID-19 in the last 14 days
DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
Your information will be encrypted.
Your browser does not support capabilities required for electronic signatures.