COVID-19 Form - R-Dentists Clinic

COVID-19 Pandemic Dental Treatment Consent Form

I, _________________, knowingly and willingly consent to having dental treatment during the COVID-19 pandemic.
I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not give the current limits in virus testing.
• I have been made aware of CDC guidelines of rendering treatment during the current pandemic. ___________ (Initial).
I am aware that my fever will be checked.
I am aware that social distancing is not possible with dentistry. ___________ (Initial)
I confirm that I am not presenting any of the following symptoms of COVID-19 listed below:
Fever/ Shortness of Breath
Dry Cough
Runny Nose
Sore Throat
Loss of smell/taste
I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus.___________ (Initial)
I verify that I have not traveled outside of Canada in the past 14 days. ___________ (Initial)
I verify that I have not traveled domestically within Canada by commercial airline, bus, or train within the past 14 days. __________(Initial)
Name
Date
Date Format: MM slash DD slash YYYY

Open For Emergencies

Covid-19 Response

Dear Valued Patients

We miss you all !

As all of our everyday routines have been drastically altered, we have come to appreciate the many things that we have been missing: For us, the simple interactions and company that you all provide in our daily lives give our work meaning and value.

As we continue to prepare ourselves for returning to regular dental care (we do not yet have a confirmed date of return), we understand that there may be a sense of apprehension. We are diligently working on our collective health and safety and wanted to update you on our latest measures:

1. We have reduced the no of seats in the reception area. and included a glass shield for the reception desk.

2. When we meet again, you will notice that we have updated our protocols of sterilization as per the public health protocols. Our sterilization area also has now been reset.

3. Our treatment rooms will have Medical Grade Air Purifier. The Surgically Clean Air system is widely recognized as the most advanced air filtration system on the market. Utilized by hospitals and many private surgical clinics, our system will completely filter the air in each room every 4 minutes. If you would like to read more about the newest additions to our office, please click here: https://scadental.com/jade/

4. Things which already in place: As you may know the dental drills work on compressed air . In our office this air is taken in from a source located in a clean, remote and fresh area. Similarly the evacuated air from the suctions is discharged to yet another area, so that these two don’t get mixed. This itself goes a big way o keep the ambient air clean. Needless to say that each time a dental drill is pressed on a gust of fresh air enters the operating room.

These are certainly unprecedented times. Never in our recent past have we collectively been asked to participate in such an act of social responsibility. Let’s ensure that this sense of community continues beyond the COVID- 19 pandemic. Together we can make a difference.

We hope that you and your loved ones are staying safe and healthy. A sincere THANK YOU to our beloved essential workers who are allowing our communities to continue to operate.

Sincerely,

Rdentists