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HOME
ABOUT US
PROCEDURES
Cleanings & Prevention
Dental Exams & Cleanings
Dental X-Rays
Digital X-Rays
Fluoride Treatment
Home Care
How to Properly Brush & Floss
Oral Hygiene Aids
Sealants
Dental Implants
Single Tooth Replacement
Multiple Teeth Replacement
Full Arch Implant Retained Devices
Frequently Asked Questions
Dental Restorations
Composite Fillings
Root Canal Therapy
Crowns (Caps)
Fixed Bridges
Inlay Restorations
Onlay Restorations
Dentures & Partial Dentures
Cosmetic Dentistry
Porcelain Crowns (Caps)
Porcelain Fixed Bridges
Porcelain Inlays
Porcelain Onlays
Porcelain Veneers
Tooth Whitening
Periodontal Disease
What is Periodontal (Gum) Disease?
Diagnosis
Treatment
Maintenance
PATIENT CENTRE
Patient Forms
New Patient Form
Medical History Update
5 Year Medical History Update
Covid-19 Patient Screening Form
COVID-19 Pandemic Dental Risk Consent
FAQs
REFERRALS
Endodontics Referral Form
BLOG
News
SERVICE AREAS
Guelph
Exhibition Park
Downtown Guelph
Riverside Park
Clairfields
Grange Hill East
Kortright Hills
Old University
St. George’s Park
Village by the Arboretum
Book An Appointment
COVID-19 Pandemic Dental Risk Consent
Guelph Royal Dental
18 Douglas St,
Guelph, ON N1H 2S9
Phone: (519) 837-1870
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Please read the patient acknowledgement below, and check off each point confirming your understanding of given point.
I understand the novel coronavirus causes the disease known as COVID-19 and that it is currently a pandemic. I understand the novel coronavirus has a long incubation period during which carriers of the virus
may not show symptoms and still be contagious
. For this reason, it is recommended to stay home and avoid close contact with other people when at all possible.
I understand the federal and provincial governments have asked individuals to maintain social distancing of at least 2 metres (6 Feet) and I recognize it is
not possible to maintain this distance while receiving dental treatment
.
I understand that oral surgery/dental procedures can create water and / or blood spray, which is one important way that the novel coronavirus can spread. The ultra-fine nature of the spray can linger in the air for minutes to sometimes hours, which can transmit the novel coronavirus.
I understand that due to the visits of other patients, the characteristics of the novel coronavirus, and the characteristics of dental procedures,
that I have an elevated risk of contracting AND SPREADING the
novel coronavirus simply by being in the dental office
.
I confirm that I do NOT have any of the following symptoms of COVID-19: fever, new or worsening cough, sore throat, runny nose or headache.
I confirm that I have not tested positive for COVID-19.
I confirm that I am not waiting for the results of a test for COVID-19.
I confirm that this is not currently a period where I required to self-isolate for 14 days.
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I verify the information I have provided on this form is truthful and accurate. I knowingly and willingly consent to have emergency surgical/dental treatment completed during the COVID-19 pandemic.
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