COVID-19 CONSENT FORM


For all patients arriving at the office:

Step 1 – when you arrive for your appointment, remain in your car and call the office at 843-577-6453. Remain in your car until we call/text you back on your phone after your chair is ready. We will not be using the waiting room at this time to comply with social distancing measures.

Step 2 – We are asking ALL patients to wear a mask or face cover until you are asked to remove the face cover.

Step 3 – Please bring in only the few items you need; iPhone, payment method, keys, face cover/mask. Leave large bags, backpacks in your car.

Step 4 – we will take your temperature before your appointment. If you have an elevated temperature, we will not treat you today.

Thank you for your patience and understanding as we are taking these steps to keep EVERYONE SAFER.

Tatum Dentistry is committed to serving our patients in the midst of the Coronavirus (COVID-19) Outbreak. For your convenience, we will remain open for dental emergencies only.

The American Dental Association has strongly recommended that we only see emergency dental patients at this time. Tatum Dentistry is offering only limited treatment during the COVID-19 National Crisis. Tatum Dentistry will evaluate each situation uniquely and decide whether or not it is emergent at this time.

COVID-19 SCREENING QUESTIONS

Have you traveled to any other countries in the last 14 days?

Have you traveled to any states outside of your current state?

If yes, Which ones?

Has anybody traveled to meet you from any countries or states?

Has anyone you’ve been in contact with, confirmed with COVID-19 virus in the last 14 days?

Has anyone you’ve been in contact with, self-quarantined due to exposure to the COVID-19 virus in the last 14 days?

Have you had any of these symptoms in the last 14 days?

Update health history and age:

If you answered yes to any of these questions, please call the office to evaluate your answers with a staff member. If you have any questions or concerns, we are happy to answer them for you.

By signing this consent form, you are allowing the appropriate treatment to be completed with Tatum Dentistry. You are aware that you are at higher risk due to the creation of aerosol and being in close proximity with each other.

Please understand that we are taking this crisis very seriously. We want to make sure our patients and staff is safe at all times.

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Trusted General, Cosmetic Dentist – Charleston, SC – Tatum Dentistry https://drtatumsmiles.com
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Document name: COVID-19 CONSENT FORM
Unique Document ID: faa36f4ae187f243f76a03e5d90f0de14929deb9
Timestamp Audit
May 9, 2020 5:49 am EDTCOVID-19 CONSENT FORM Uploaded by Victoria Tatum - patientcare@drtatumsmiles.com IP 45.127.194.228