New Patient Forms
Pre-appointment Screening and Informed Consent
SUPPLEMENTAL
INFORMED CONSENT
Dental Treatment in the Era of COVID-19
Thank you for your continued trust in our practice. As with the transmission of any communicable disease like a cold or the flu, you may be exposed to COVID-19, also known as the “Coronavirus,” at any time or any place. Be assured that we always followed state and federal regulations and recommended universal personal protection and disinfection protocols to limit transmission of all diseases in our office and continue to do so.
Despite our careful attention to sterilization, disinfection, and use of personal barriers, there is still a chance that you could be exposed to an illness in our office, just as you might be at the gym, grocery store, or favorite restaurant.
“Social Distancing” nationwide has reduced the transmission of the Coronavirus. Although we have taken measures to provide social distancing in our practice, due to the nature of the procedures we provide, it is not possible to maintain social distancing between the patient, dentist, dental staff and sometimes other patients at all times.
Although exposure is unlikely, do you accept the risk and consent to treatment?
Pre-Appointment Health Screening
Get In Touch

Call
(239) 334-2242
Address
8900 Gladiolus Dr.
Fort, Myers FL 33908
Hours
Mon - Thurs: 8am - 5pm