Covid-19 Consent Form
SUPPLEMENTAL INFORMED CONSENT/QUESTIONNAIRE Communicable Diseases and Your Dentist
Vienna Dental Care
With community transmission of communicable diseases, you could be exposed anywhere to infectious diseases including, but not limited to COVID-19 (also called Coronavirus). Our dental office is following the State and Federal regulations and recommended universal personal protection and disinfection protocols to limit transmission of communicable diseases. However, it is possible that these precautions will not always be successful in blocking the transmission of these diseases. Social distancing nationwide has reduced the transmission of COVID-19; however it is not possible to provide dental treatment with social distancing between the patient and dentist; dentist and staff and sometimes between other patients. By presenting yourself or your child for dental treatment, you accept the risk that you or your child may inadvertently be exposed to a communicable disease. If you have been exposed to a communicable disease prior to your appointment, you may spread the disease to the dentist, staff and to other patients/parents in the practice. Therefore, prior to each appointment, we require you to answer the following questions: