COVID-19 Dental Treatment Consent

Please complete this online form the evening prior to your appointment with Dr. French. CMOH Order 05-2020 legally requires you to be in isolation for a minimum of 10 days at the onset of new symptoms, or until symptoms resolve, whichever is longer. If you are experiencing any symptoms related to COVID-19, we strongly suggest you complete the online COVID-19 Assessment tool at https://myhealth.alberta.ca/Journey/COVID-19/Pages/COVID-Self-Assessment.aspx

  • MM slash DD slash YYYY
  • Initials Required
  • Initials Required

  • Symptoms

    If you answer "yes" to any of the following questions, please give our office a call at 403.247.8656 before you come in.
  • A fever is characterized by temperature of more than 38 degrees Celsius.
  • Chills/ Fatigue/ Muscle aches/ Headache/ Vomiting/ Diarrhea

  • High Risk Patients

  • Initials Required
  • Initials Required (IF APPLICABLE)

  • COVID-19 Testing

  • Initials required
  • Initials Required
  • Initials Required

  • CONSENT

  • Initials Required
  • Initials Required