🦷 Comprehensive Dental Care



Dental Treatment and Office Visit Consent (COVID-19)

I acknowledge that I have read the information below, and verify that I will abide by all the terms listed below for my upcoming dental visit.

First and Last Name:



*I will wear a mask before and after my appointment, and continue to follow social distancing guidelines.

*If I have any one of the symptoms listed below in the past two weeks or have been in contact with a person with these symptoms, I will notify the office BEFORE leaving for my appointment.
Symptoms: acute onset fever, cough/lower respiratory symptoms, runny nose, loss of taste or smell, body aches, gastrointestinal upset, flu-like symptoms

*I will wait in my vehicle or outside until it is time for my appointment. I will only enter when it is time for my appointment.

*I will have family members or companions wait in the vehicle or outside.

*I will call the office if I am running early or late, in preparation of my entry.

*Before starting my appointment, my temperature will be taken; I will wash/sanitize my hands; and I will pre-rinse with an antiseptic rinse once seated.

*If I have tested positive for COVID-19 or been in contact with a positive tested individual, I will wait for 72 hours after the recovery and quarantine period before calling.

*I understand that if I have any of the following conditions, I am at increased risk to dangers of COVID-19: heart disease, lung disease, kidney disease, diabetes, any auto-immune disorders, or over the age of 60.

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Implant, Family, and Cosmetic Dentistry, Dentist in Montville, New Jersey
Bobby S. Lee, DDS - Dentist Montville New Jersey - Implant Cosmetic Family Dentistry
170 Changebridge Rd. Suite C-1
Montville, NJ 07045 USA
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