• COVID-19 Pandemic

    Dental Treatment Consent Form
  • Even after following protocols set by the American Dental Association and our state’s dental association, it is still possible to contract COVID-19 while at a dental office. We are following all guidelines to minimize the risk of transmission.
  • - Fever
    - Shortness of breath
    - Dry cough
    - Runny nose
    - Sore throat
  • We ask that you please refrain from using your cell phone and having it out while in the office
  • (Patient or legal guardian)
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.