We ask you to fill out this form to minimize and monitor to the best of our ability any transmission of communicable disease and prevent further community spread. If you or your acquaintances have been exposed to a communicable disease such as COVID-19, you may spread the disease to the dentist, staff, or other individuals in the practice. Therefore, prior to each appointment, fill out this form and consent.
Our office have always followed strict state and federal regulations and recommendations regarding dental care such as strict disinfection protocols and personal protection equipment to limit any transmission of any diseases and will continue to do so. However, as with any communicable disease like the common cold or flu, you may be exposed to COVID-19 at anytime or place. Despite our strict disinfection, sterilization, and PPE protocols, there is still a chance, however small, that you could be exposed to an illness in our office, just as you might in any public space. We have taken every measure to provide social distancing in our practice, but due to the nature of dental care, it is not possible to maintain social distancing between the patient, dentist and staff at all times.
If you responded YES to any of these questions, or have experienced Fever, Cough, Shortness of Breath/Trouble Breathing, Pain, Pressure, or Tightness in the Chest in the past 30 days, please call our office prior to your appointment to reschedule at least 14 days from your original appointment.