understand that I am, of my own free will, proceeding forward with an elective treatment that is not urgent, may be esthetic in nature, and may not be medically necessary.
I am fully aware of the worldwide coronavirus, COVID-19 pandemic which is contagious and is spread by person-to-person contact, I am aware of all of the possible consequences of a COVID-19 infection. I understand that by consenting to these elective treatments, there is a risk of becoming infected with COVID-19 just as I might be at any venue I visit.
Accordingly, I acknowledge and assume the risk of becoming infected with COVID-19 through this elective treatment, and I give my express permission for the healthcare providers and staff at Mary Cresseveur-Reed, DDS, FAGD, to proceed with these treatments.
I understand that COVID-19 may cause additional risks, some of which may not currently be known at this time, in addition to the risks described in this Informed Consent, as well as those risks for the elective treatments I receive.
I have been given the option to defer my elective treatments to a later date. I understand all the potential risks, including, but not limited to the potential short-term and long-term complications related to COVID-19, and I would like to proceed with my desired treatment. I acknowledge that I have been offered a copy of this consent form.
I UNDERSTAND THE EXPLANATION AND HAVE NO MORE QUESTIONS AND CONSENT TO THE PROCEDURE.