COVID-19 Consent

Thank you for trusting our practice. As with the transmission of any communicable disease, like a cold or the flu, you may be exposed to COVID-19, also known as “coronavirus,” at any time or in any place. 

We've always followed state and federal regulations and recommended universal personal protection and disinfection protocols to limit the transmission of all diseases in our office and we'll continue to do so.

Despite our careful attention to sterilization, disinfection, and use of personal barriers, there's still a chance that you could be exposed to an illness in our office, just as you might be at your grocery store or favorite restaurant. 

Nationwide social distancing practices have reduced the transmission of the coronavirus. Although we've taken measures to provide social distancing in our practice, due to the kind of treatment we provide, it's not possible to maintain social distancing between the patient, orthodontist, orthodontic staff, and sometimes other patients at all times.

Although exposure is unlikely, do you accept the risk and consent to treatment?



Patient/Parent’s Signature​

 
Date: