I willingly consent to dental treatment provided by Onsite Dental Care and any designated associates and team members during the COVID-19 pandemic.

I understand that Onsite Dental Care is following CDC and ADA guidelines and recommendations to:

• Screen Patients and Employees for exposure of infection with COVID-19
• Use proper PPE
• Take measures to reduce aerosol
• Reduce the number of patients on site as well as encourage social distancing

I understand that the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms yet are still highly contagious.

I understand that dental care creates aerosol (water spray) which is one way the disease is spread.

I understand that due to the nature of dental visits, characteristics of the virus and the characteristics of dental procedures that I have the risk of contracting the virus even though mandates are being observed.

Informed Consent: I have been given the opportunity to ask any questions regarding the risk of contracting COVID-19 from the dental office and dental procedures. I reaffirm that to the best of my knowledge I am not a carrier or infected with COVID-19. I acknowledge that the purpose of the dental procedures under current circumstances and restrictions have been explained to me.