Registration

1. The above information given by me is true to the best of my knowledge. I fully understand and acknowledge that withholding or mis-representation of any information is highly unethical and against the interest of larger population during this pandemic.
2. I have been made aware that dental procedures create ultra-fine water spray that may transmit the COVID-19 virus. I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. I also understand that, due to the contagious nature of the disease and characteristics of dental procedures, i have an increased risk of contacting the virus simply by being in a dental office inspite of the best disinfection protocols applied.
3. I fully understand and acknowledge that i may be an asymptomatic carrier of the disease and hence will strictly comply with all safety precautions and protocols advised. In the eventuality of my testing COVID-19 positive at a later date, i will not hold the dental service provider/staff/dental set-up responsible for it. I here by knowingly and willingly give consent to have my emergency/urgent dental treatment completed during the COVID-19 pandemic.

1. The treatment procedures together with the advantages and risks have been explained to me and so have the potential consequences of not undergoing the treatment.
2. I understand that the diagnosis and treatment may be performed by the chief dentist, associate dentist, consultant dentist or supervised staff.
3. I give my consent to any advisable and necessary dental procedures, medications or anesthetics to be administered related to my treatment, by dentist or supervised staff.
4. The procedure may include certain pre and post photographs by the attending dentist or supervised staff for diagnostic procedure or related to dental treatment. I also give my consent to avail consultation via Telemedicine.