I understand the novel coronavirus causes the disease known as COVID-19. I understand the novel coronavirus has a long incubation period during which carries of the virus may not show symptoms and still be contagious.
I confirm that I am not presenting any of the following symptoms of COVID-19 identified by the Ontario Health Services:
I verify the information I have provided on this form is truthful and accurate. I knowingly and willingly consent to have the above listed dental treatment completed during the COVID-19 pandemic.