COVID-19 Questionnaire & Consent

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Patient Information

Risk of infection

At [INSERT PRACTICE NAME], we follow all requirements for Infection Control and Prevention, including all enhanced directives issued. We are taking all necessary precautions to prevent transmission of COVID-19, along with any and all other infection causing viruses or bacteria. Certain dental procedures create a water spray which is one way that the novel coronavirus can spread. Despite these efforts, given the unique attributes of the novel coronavirus, there may be an elevated risk of infection.

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I hereby consent to dental treatment despite any possible elevated risks associated with such treatment during this time of the COVID-19 pandemic, which risks have been explained to me.

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