COVID19 Risk Acknowledgement
I accept that there is an increased risk of contracting the COVID19 virus in the dental office or during dental treatment. I further
confirm that I understand and accept the additional risk of contracting COVID19 from contact at this office. I also understand that
I could contract the COVID19 virus outside this office and unrelated to my working here. I hereby release, covenant not to sue,
discharge, and hold harmless the clinic, its employees, agents, and representatives, of and from the Claims, including all
liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that
this release includes any Claims based on the actions, omissions, or negligence of the clinic, its employees, agents, and
representatives, whether a COVID-19 infection occurs before, during, or after my dental appointment.