COVID-19 Pandemic Emergency Dental Treatment Consent

Please correct the errors described below.

knowingly and willingly consent to have emergency dental treatment completed during the COVID-19 pandemic.

I understand the COVID-19 virus has a long incubation period during which carries of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not given the current limits in virus testing.

Dental procedures create water spray. It is unclear as to how long the ultra-fine nature of the spray may linger in the air, which can transmit the COVID-19 virus.

I confirm that I am not presenting any of the following symptoms of COVID-19 listed below:

  • Fever
  • Shortness of Breath
  • Loss of Sense of Taste and Smell
  • Dry Cough
  • Sore Throat

I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. The CDC recommends social distancing of at least 6 feet for a period of 14 days, however this is not possible with dentistry due to dental procedures.

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