Informed Consent During COVID-19


INFORMED CONSENT

 Patient Advisory and Acknowledgment 

Receiving Dental Treatment During the COVID-19 Pandemic 

       Dear Patient Guardian:

 You have presented to the office today to have your child receive dental care to prevent conditions which may become            
 progressively worse over time.

 Please be advised of the following:

        While our office complies with State Health Department and the Centers for Disease Control and Prevention infection control
        guidelines to prevent the spread of the COVID-19 virus, we cannot make any guarantees.

        Our staff members are symptom-free and, to the best of their knowledge, have not been exposed to the virus. However, since we are  a
        place of public accommodation, other persons (including other patients) could be infected, with or without their knowledge.

                              In order to reduce the risk of spreading COVID-19, we have asked you a number of “screening” questions.
                              We require the use of face mask/face covering by all persons entering the office.  For the safety of our staff, other patients,
                              and yourself, we expect your answers have been truthful.