COVID-19 Dental Treatment Consent Form

I knowingly and willingly consent to have dental treatment completed on myself or on my child during the COVID-19 pandemic. 

I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not given the current limits in virus testing.

Dental procedures create water spray which is how the disease is spread. The ultra-fine nature of the spray can linger in the air for minutes to sometimes hours, which can transmit the COVID-19 virus.

Your Signature

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© 2020 Happy Teeth Dental Care, PC

Happy Teeth Dental Care

135 Boston Turnpike 

Shrewsbury, MA 01545

Office Phone Number: (508) 425-3316

Office Fax Number: (508) 753-3318