I am aware that the current COVID-19 pandemic brings a number of known risks and a number of unknown risks. I have chosen to seek dental treatment during the pandemic in the knowledge that much is still unknown about the virus.  

 

I understand the coronavirus that causes COVID-19 has a long incubation period during which time carriers of the virus may not show symptoms yet still be highly contagious. I also understand that some people may have the virus but may not ever have any symptoms. I therefore understand it is impossible to determine who has the virus and I understand that I must assume that anyone anywhere could be infected and infectious

I have been made aware that during the current phase of the pandemic some routine dental care may need to be postponed

I confirm that I am not currently suffering from any of the following symptoms of COVID-19 and I have not suffered from any of these symptoms in the last 7 days:-

·         Fever (a temperature of 37.8 degrees Centigrade or above).

·         A new persistent dry cough.

·         Shortness of breath and breathing difficulties.

·         Loss of taste and/or smell.

·         Extreme fatigue/muscle pain

I confirm that I have not been in close contact (within 2 metres) of anyone showing symptoms of COVID-19 in the last 14 days

I understand that receiving dental treatment means that the UK government’s instruction to maintain social distancing of at least 2 metres is not achievable during treatment. However, I understand that my dentist will take every precaution to make sure that my treatment provided is in accordance with enhanced clinical protocols