COVID-19 Patient Notice & Acknowledgment Form

Please correct the errors described below.

As you are aware, the Centers for Disease Control and Prevention has issued warnings and precautions to health care providers worldwide regarding coronavirus and COVID-19.

Here at Joel D. Singer, DMD we are taking every precaution to limit the exposure to any virus within our office community and we ask that you participate in the taking these precautions.

In our efforts to protect the safety of the practice community as well as the community at large, it is the policy of Joel D. Singer, DMD to reschedule a patient’s appointment for elective care if the patient is exhibiting symptoms of COVID-19, recently traveled abroad or to a high risk area, or was subject to a known exposure event.

In placing your signature below, you attest to the truth of your answers above and your understanding of Joel D. Singer, DMD office policy. We thank you and look forward to a return to normal practice.

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