Sein H. Siao, DMD & Associates, PC
YOU ARE RECEIVING DENTAL CARE DURING THE EVENTS OF A COVID-19 NATIONAL EMERGENCY. PLEASE BE ADVISED THAT THERE MAY BE RISKS IN BEING IN THE PROXIMITY OF DENTISTS, PATIENTS, OR STAFF. WE ARE TAKING PRECAUTIONS TO LIMIT THE SPREAD OF DISEASE, YET THERE IS STILL A POSSIBILITY OF TRANSMISSION.
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.
Click a signature you want to use: