COVID-19 Pandemic Dental Treatment Consent Form

  • 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 am aware that my fever will be checked.

  • Fever/ Shortness of Breath
    Dry Cough
    Runny Nose
    Sore Throat
    Loss of smell/taste
  • Date Format: MM slash DD slash YYYY