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Patient Consent for Dental Treatment in the Era of COVID-19

Thank you for your continued trust in our practice. As with the transmission of any communicable viral disease like a cold or the flu, you may be exposed to the COVID-19 virus (SARS-CoV-2), also known as “coronavirus,” at any time or in any place.

Be assured that we continue to follow state and federal regulations as well as recommended universal personal protective equipment (PPE) and disinfection protocols to limit transmission of all diseases in our office.

We implement careful attention to sterilization, disinfection and the use of personal barriers, however, there is still a chance that you could be exposed to an illness in our office, just as you might be exposed at your gym, church, gas station, grocery store or favorite restaurant. Social distancing has reduced the transmission of the coronavirus. Although we have taken measures to enable social distancing in our practice, due to the nature of the procedures we provide, it may not be possible to maintain social distancing between the patient and the dental healthcare team members at all times. We will be implementing procedures to help minimize interactions between patients and request that you work with us on this change in routine. New protective gear and wear are being utilized to protect us, and you, as much as possible, from COVID-19 (SARS-CoV-2).




I have been offered a copy of this consent form (patient’s initials) _______