COVID-19 Consent Wake Dental Care - COVID-19 ConsentCurrently there is some increased risk associated with in-office evaluation and treatment duringthe COVID pandemic. These risks include:• Exposure to other patients• Exposure to healthcare staff• Exposure to healthcare facilitiesPatients in the following categories and with the following health conditions are at greater risk:• Asthma• Chronic lung disease• Diabetes• Serious heart disease/conditions• Chronic kidney disease• Severe obesity• Age 65 or older• Nursing home or long-term care facility residents• Immunocompromised or immune suppressed patients• Liver disease• PregnancyIf you have one or more of these problems, you may be at greater risk for contracting COVID. Ifyou contract COVID, you may be at greater risk to develop complications, including seriouscomplications, possibly leading to hospitalization and, in rare situations, death.Alternative Evaluation and Treatment ChoicesThere are alternative means of evaluation and treatment that may be appropriate for you. Thesealternatives include:• Phone evaluation• Telehealth/Teledentistry evaluation via videoThese alternatives may or may not be appropriate for you depending on your specific problemand underlying health conditions. If remote assessment and treatment are not sufficient, yourdoctor will attempt to answer questions and explain why an in-office evaluation is recommendedin your circumstance.More FactsMedical staff and office personnel may help your doctor during intake, evaluation and treatment. They will follow state laws and current recommendations from local, state and national health officials related to screening patients for alternative means of evaluation and performance of in office assessments and care. Although we are taking steps to reduce risks, we cannot completely eliminate these risks, especially for higher risk patients.Consent to TreatmentThe first page of this consent form told you about COVID-related risks. If, after reviewing this form, you do not believe that you really understand the risks and choices, do not sign the form until all questions have been answered. I Consent I understand the facts provided to me on the first page of this consent form. I give my consent for in-office evaluation and treatment. By signing below, I agree that staff/doctor has discussed the facts in this form with me, that no one has given me any guarantee, that I have had a chance to ask questions, and that all of my questions have been answered. I Consent SignatureName* First Last Email* Phone*Message 44055
