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R-Dentists Clinic
(905) 567-6757
info@rdentists.com
Manulife Corporate Park 102 - 6733 Mississauga Road Mississauga, ON L5N 6J5
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RECONSTRUCTIVE & SURGICAL DENTISTRY
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(905) 567-6757
HOME PAGE
SERVICES
GENERAL & FAMILY CARE
DENTURES
EMERGENCIES
GUM DISEASE PERIODONTAL TREATMENT
DEEP CLEANING, SCALING & ROOT PLANING
ROOT CANAL THERAPY
COSMETIC DENTISTRY
ORTHODONTICS BRACES
CROWNS & BRIDGES
PORCELAIN VENEERS
TEETH WHITENING
INVISALIGN
FILLINGS
RECONSTRUCTIVE & SURGICAL DENTISTRY
DENTAL RESTORATION
SMILE REHABILITATION
EXTRACTIONS AND WISDOM TEETH REMOVAL
SLEEP DENTISTRY
CONSULTATION ONLINE
EMERGENCIES
TEAM
SMILE GALLERY
CONTACT
Menu
HOME PAGE
SERVICES
GENERAL & FAMILY CARE
DENTURES
EMERGENCIES
GUM DISEASE PERIODONTAL TREATMENT
DEEP CLEANING, SCALING & ROOT PLANING
ROOT CANAL THERAPY
COSMETIC DENTISTRY
ORTHODONTICS BRACES
CROWNS & BRIDGES
PORCELAIN VENEERS
TEETH WHITENING
INVISALIGN
FILLINGS
RECONSTRUCTIVE & SURGICAL DENTISTRY
DENTAL RESTORATION
SMILE REHABILITATION
EXTRACTIONS AND WISDOM TEETH REMOVAL
SLEEP DENTISTRY
CONSULTATION ONLINE
EMERGENCIES
TEAM
SMILE GALLERY
CONTACT
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Instagram
Google-plus
COVID-19 Pandemic Dental Treatment Consent Form
Step 1 of 9
11%
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.
*
Acknowledge
I have been made aware of CDC guidelines of rendering treatment during the current pandemic.
*
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I am aware that my fever will be checked.
I am aware that social distancing is not possible with dentistry.
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I confirm that I am not presenting any of the following symptoms of COVID-19 listed below:
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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.
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I verify that I have not traveled outside of Canada in the past 14 days.
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I verify that I have not traveled domestically within Canada by commercial airline, bus, or train within the past 14 days.
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I agree to the privacy policy.
(905)567-6757
6733 Mississauga Road, Suite 102
Mississauga, ONL5N6J5
Toll Free: 1(866)567-3368(DENT)
Fax: (905)567-8134
Email: info@rdentists.com
Website: www.rdentists.com
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