I understand the novel coronavirus causes the disease known as COVID-19. I understand the novel coronavirus virus has a long incubation period and carriers of the virus may not show symptoms and still be contagious.
I understand that dental procedures create water spray which is one ways 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 frequency of visits of other dental patients, the characteristics of the novel coronavirus, and the characteristics of dental procedures, that I have an elevated risk of contracting the novel coronavirus simply by being in a dental office.
I confirm that I am not presenting any of the following symptoms which are new or worsened if associated with allergies, chronic or pre-existing conditions: fever (adults >37.8*C pediatrics >38*C), cough, shortness of breath, difficulty breathing, sore throat and/or runny nose, loss of or change to my sense of smell and/or taste, vomiting, diarrhea.
I will notify SCOMS (via patient intake process or verbally) if I am high risk for COVID-19 ie. been diagnosed with any of the following: diabetes, cardiovascular disease, hypertension, lung diseases including moderate to severe asthma, being immunocompromised, having active malignancy, or over the age 65.
I confirm that I am not knowingly positive for the novel coronavirus. I also confirm that I am not waiting for the results of a laboratory test for the novel coronavirus.
I verify that if I have travelled anywhere outside of Canada in the last 14 days, that I meet the Government of Canada Quarantine Exemption Criteria.
I verify that I have not been identified as a contact of someone who has tested positive for novel coronavirus or been asked to self-isolate by Alberta Health, the Communicable Disease Control or any other governmental health agency.