COVID 19 Emergency Treatment Consent

A consent form for emergency dental treatment during the COVID-19 pandemic. The patient initials statements acknowledging that carriers may show no symptoms, that dental procedures create aerosols, and that being in a dental office carries a higher risk of exposure. They also confirm awareness of CDC and ADA guidance limiting care to urgent conditions and that their condition meets those criteria.

This form was written for the period when only urgent care was recommended. Keep it on file as a model for consent during a future public health emergency, and update the guidance it cites before using it with any patient.