Based on your responses you may continue to come to the clinic for your appointment.
In the wake of current COVID 19 pandemic, I have come to Douglass Dentistry for dental treatment. The doctors reserve the right to TREAT / DEFER / REFER me accordingly. If I happen to be an asymptomatic Carrier or an undiagnosed patient with COVID-19 disease, I suspect it may endanger doctors and clinical staff. It is my duty and responsibility to take appropriate precautions and follow the protocols prescribed by them. I also know and understand that I may get an infection from the dental clinic or from the doctor and I will take every precaution for this from happening, but I will not hold Doctor/s or the staff if such infection occurs to me or my accompanying person. I verify confirm and agree to be held accountable, regarding the details given by me are true to my knowledge and I agree to all the terms and conditions mentioned in this form.
- Please wear a face mask while entering the premises.
- Disinfect your hands with sanitizer on arrival and before leaving.
- Notify reception by phone on your arrival. We may ask you to wait outside or in your vehicle until Doctor/Hygienist is ready to see you.
- If you need to cough or sneeze, please cover your mouth and nose with a tissue, then throw the tissue in the trash and wash your hands or use sanitizer.
- No visitors allowed in office, patient only (unless accompanying adult is required).