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  • COVID-19 Pandemic Emergency Dental Treatment Notice & Acknowledgement of Risk Form

  • Our goal is to provide a safe environment for our patients, staff, and community and to uphold all protocols and guidelines of our governing authorities. This document provides information and acknowledgment pertaining to you regarding the COVID-19 virus (coronavirus).

     

    Our practice wants to ensure you are aware of the risks of contracting the virus associated with dental care. The COVID-19 virus is a highly contagious disease that has been classified as a global pandemic. What makes the virus dangerous is that there many ways that it can spread to a host. The virus has a long incubation period (roughly 2 weeks) and for most cases are asymptomatic but the host is still very contagious during this time. Additionally, with the virus being relatively new it is very complicated and challenging to determine infection rate due to the lack of viral testing available. 


    Thus, with all those factors: frequency and timing of visits by other dental patients, the virus’s characteristics, and characteristics of dental procedures, there is an elevated risk of you contracting the virus by visiting the dental office. During your dental treatment, we will use water spraying which is one possible way the virus can travel. The nature of the water spray technique can linger in the air for an extended period of time thus allowing the transmission of the virus to those nearby. Additionally, the patient can not wear a protective mask to prevent infection as the doctor will need to have access to the mouth in order to complete the recommended treatment. 


    Following the regulations from the Center for Disease Control (CDC) and the American Dental Association (ADA), non-essential or elective treatment, based on the assessment of our staff, will be rescheduled. According to the ADA, dental emergencies are considered “potentially life-threatening and require immediate treatment to stop ongoing tissue bleed [or to] alleviate severe pain or infection.” Also, the ADA recommends that urgent dental care focus “on the management of conditions that require immediate attention to relieve severe pain and/or risk of infection and to alleviate the burden on hospital emergency departments” to be provided in a minimally invasive manner as possible. 


    By signing below I have confirmed that I have read the Notice above and understand and accept the risks associated with my dental care with the risks related to COVID-19. I further confirm I am seeking treatment for a condition that meets the emergent or urgent criteria noted above. I understand and accept the additional risks of the COVID-19 related in a dental setting. I also acknowledge that I could contract the COVID-19 virus from outside the practice and unrelated to my visit here. 


    I have read and understood all the information provided above: 

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