Patient Advisory & Acknowledgment – Receiving Treatment During the COVID-19 Pandemic
Dear Patient,
You have come to our office today for a routine dental evaluation and/or treatment that will be done during COVID-19 pandemic. Please be advised of the following:
– While our office complies with the infection control guidelines set by the State Health Department and the Centers for Disease Control & Prevention to prevent the spread of the COVID-19 virus, we cannot make any guarantees.
– Our staff 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 it without their knowledge.
In order to reduce the risk of spreading COVID-19, we are asking you a number of “screening” questions below. For the safety of our staff, other patients, and yourself, please be truthful and candid in your answers.