Welcome to our dental office. To assist us in serving you, the information provided in this form is important to your health. To obtain the best and safest treatment, your dentist needs to know of any problems which may affect your treatment. If you have any questions, don't hesitate to ask.
Dental History & History of present illness
I give my consent to any advised and necessary dental procedures, medication or anaesthetics to be administered by the attending dentist. I understand that long term success of treatment and status of my oral condition depends on my efforts at proper oral hygiene and regular recall visits. I have been explained the treatment procedure, possible complications and side effects in detail. I also declare that the above information provided by me is correct.
COVID-19 Pandemic Dental Treatment Consent
I am aware that I may get an infection from the clinic or from a doctor, and I will take every precaution to prevent this from happening, but I will not at all hold doctors and clinic staff accountable if such infection occurs to me or my accompanying persons.
In case I or my attendant get the COVID 19 infection after the visit to the clinic, I will inform the clinic authorities at the earliest, so that appropriate tracking of the patients/attendants and clinic staff present on the day of my visit can be done.