COVID-19 Pandemic Dental Treatment Consent Form 

​I confirm that I am NOT presenting any of the following symptoms of COVID-19 identified by Alberta Health Services: 

Do you have a fever > 38°C?
New cough or worsening chronic cough?
Sore throat or is it painful swallowing?
New or worsening shortness of breath?
Difficulty Breathing?
Flu-like symptoms?
Runny nose?

or

Patient Signature

 

AT WESTSIDE ENDODONTICS WE ARE ADHERING TO ALL COVID-19 PROTOCOLS FROM THE ALBERTA DENTAL ASSOCIATION & COLLEGE AS WELL AS ALBERTA HEALTH SERVICES TO KEEP OUR PATIENTS & STAFF SAFE.

Call to schedule
an appointment with us.

(403) 457-8400

14 – 7400 Macleod Trail SE
Calgary, AB T2H 0L9

Phone:  (403) 457-8400

Fax:      (403) 775-4409

Email:   info@wsendodontics.com

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