I confirm that I am not presenting any of the following symptoms of COVID-19 listed below:
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FEVER (feeling hot to touch, a temperature of 100 degrees Fahrenheit or higher)
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CHILLS
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COUGH that's new or worsening (continuous, more than usual)
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BARKING COUGH, making a whistling noise when breathing ('CROUP')
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SHORTNESS OF BREATH (out of breath, unable to breathe deeply)
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SORE THROAT
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DIFFICULTY SWALLOWING
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RUNNY NOSE (not related to seasonal allergies or other know causes or conditions)
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NASAL CONGESTION (not related to seasonal allergies or other known causes or conditions)
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LOSS OF SENSE OF SMELL
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PINK EYE (conjunctivitis)
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HEADACHE that's unusual or long-lasting
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DIGESTIVE ISSUES (nausea/vomiting, diarrhea, stomach pain)
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MUSCLE ACHES
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EXTREME TIREDNESS THAT IS UNUSUAL (fatigue, lack of energy)
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FALLING DOWN MORE THAN USUAL
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FOR YOUNG CHILDREN & INFANTS: Sluggishness or lack of appetite
I verify that I have not traveled outside of Canada in the past 14 days and have not been in touch with anyone with covid/potential covid in the last 14 days.
I, knowingly and willingly consent to have dental treatment completed during the COVID-19 pandemic.
Thank you for doing your part in keeping everyone safe. Please note the following:
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wear a MASK when entering the dental office
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SANITIZE your hands immediately upon arrival
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maintain Social Distancing from other patients
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have your Temperature taken by our team members
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not have any Accompaniment except small child/caregivers/translators