COVID-19 Staff Consent

All Staff are Required to Complete This Consent Form Prior to Each Shift

To ensure the health and safety of both our patients and staff during the COVID-19 pandemic, we require submission of consent in order for patients and staff to attend appointments.


PLEASE COMPLETE THE STAFF CONSENT FORM BELOW:

CMOH Order 05-2020 legally obligates any person who has the following cough, fever, shortness of breath, runny nose, or sore throat (that is not related to a pre-existing illness or health condition) to be in isolation (quarantine) for 10 days from the start of symptoms, or until symptoms resolve, whichever takes longer. If they are exhibiting any of these symptoms, it is suggested they complete the COVID-19 Self-Assessment online tool to determine if they should be tested.

* Required


Thank you for being an integral part of the Tooth Suite Family Dentistry Team!