Our Governor allowed dental offices to re-open for elective treatment with certain safeguards. All patients, dentists and staff (both front and back) will be screened for COVID-19 daily.
The Center of Disease Control identified nine symptoms associated with Coronavirus.
My Temperature at ___ : ___ am/pm is ____ºF. [The dental office will fill in this line.] You will be asked to leave if your temperature meets or exceeds 100.4 ºF. The CDC considers such a reading to indicate a fever.
Please complete all questions below. In the past 24 hours:
As of this morning, none of our doctors or staff exhibit any Coronavirus symptoms (using the same screening as above); however, we have NOT BEEN MEDICALLY TESTED for COVID-19 and cannot guarantee that either we or our other patients are Coronavirus-free.
For your safety, our office has increased hygiene measures since the outbreak.
Given this knowledge, and knowing that I possibly could contract COVID-19 at this office (through the doctors, staff, or from other patients, and despite the office’s best intentions), I nevertheless voluntarily wish to continue with my elective dental treatment and hold the doctor and staff harmless should I come down with Coronavirus.
I have read this page and the content in full and have no questions.