{"id":2121,"date":"2021-05-01T12:03:04","date_gmt":"2021-05-01T18:03:04","guid":{"rendered":"https:\/\/drdavidfrench.ca\/?page_id=2121"},"modified":"2021-09-20T09:41:04","modified_gmt":"2021-09-20T15:41:04","slug":"covid-19-consent","status":"publish","type":"page","link":"https:\/\/drdavidfrench.ca\/covid-19-consent\/","title":{"rendered":"COVID-19 Dental Consent"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_4' >\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">COVID-19 Dental Treatment Consent<\/h3>\n                            <p class='gform_description'>Please complete this online form the evening prior to your appointment with Dr. French.\r\nCMOH 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\r\n\r\n\r\n<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_4'  action='\/wp-json\/wp\/v2\/pages\/2121' data-formid='4' > \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n                        <div class='gform-body gform_body'><ul id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_4_2\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_2\"><label class='gfield_label gform-field-label' for='input_4_2' >Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_2' id='input_4_2' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_4_2_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_4_2_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_4_2' class='gform_hidden' value='https:\/\/drdavidfrench.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_4_1\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_1\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_4_1'>\n                            \n                            <span id='input_4_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_4_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_4_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_4_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_4_12\"  class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_12\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Name of Accompanying Visitor (If Applicable)<\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_4_12'>\n                            \n                            <span id='input_4_12_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_12.3' id='input_4_12_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_4_12_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_4_12_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_12.6' id='input_4_12_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_4_12_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_4_10\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_10\"><label class='gfield_label gform-field-label' for='input_4_10' >I understand the novel coronavirus causes the disease known as COVID-19. I understand the novel coronavirus has a long incubation period during which carriers may not show symptoms but still be contagious.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_10'>Initials Required<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_10' id='input_4_10' class='textarea small'  aria-describedby=\"gfield_description_4_10\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_4_11\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_11\"><label class='gfield_label gform-field-label' for='input_4_11' >Due to the frequency of visits of other dental patients, the nature of the novel coronavirus, and the characteristics of dental procedures, I understand that I have an elevated risk of contracting COVID-19 by simply visiting a dental office.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_11'>Initials Required<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_11' id='input_4_11' class='textarea small'  aria-describedby=\"gfield_description_4_11\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_4_9\"  class=\"gfield gfield--type-section gsection form-section field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_9\"><h2 class=\"gsection_title\">Symptoms<\/h2><div class='gsection_description' id='gfield_description_4_9'>If you answer \"yes\" to any of the following questions, please give our office a call at 403.247.8656 before you come in. <\/div><\/li><li id=\"field_4_14\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_14\"><label class='gfield_label gform-field-label'  >Do you have a fever?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_14'>A fever is characterized by temperature of more than 38 degrees Celsius.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_14'>\n\t\t\t<li class='gchoice gchoice_4_14_0'>\n\t\t\t\t<input name='input_14' type='radio' value='Yes'  id='choice_4_14_0'    \/>\n\t\t\t\t<label for='choice_4_14_0' id='label_4_14_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_14_1'>\n\t\t\t\t<input name='input_14' type='radio' value='No'  id='choice_4_14_1'    \/>\n\t\t\t\t<label for='choice_4_14_1' id='label_4_14_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_15\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_15\"><label class='gfield_label gform-field-label'  >Do you have a new cough or worsening chronic cough?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_15'>\n\t\t\t<li class='gchoice gchoice_4_15_0'>\n\t\t\t\t<input name='input_15' type='radio' value='Yes'  id='choice_4_15_0'    \/>\n\t\t\t\t<label for='choice_4_15_0' id='label_4_15_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_15_1'>\n\t\t\t\t<input name='input_15' type='radio' value='No'  id='choice_4_15_1'    \/>\n\t\t\t\t<label for='choice_4_15_1' id='label_4_15_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_16\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_16\"><label class='gfield_label gform-field-label'  >Do you have a sore throat and painful swallowing?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_16'>\n\t\t\t<li class='gchoice gchoice_4_16_0'>\n\t\t\t\t<input name='input_16' type='radio' value='Yes'  id='choice_4_16_0'    \/>\n\t\t\t\t<label for='choice_4_16_0' id='label_4_16_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_16_1'>\n\t\t\t\t<input name='input_16' type='radio' value='No'  id='choice_4_16_1'    \/>\n\t\t\t\t<label for='choice_4_16_1' id='label_4_16_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_17\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_17\"><label class='gfield_label gform-field-label'  >Do you have difficulty breathing?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_17'>\n\t\t\t<li class='gchoice gchoice_4_17_0'>\n\t\t\t\t<input name='input_17' type='radio' value='Yes'  id='choice_4_17_0'    \/>\n\t\t\t\t<label for='choice_4_17_0' id='label_4_17_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_17_1'>\n\t\t\t\t<input name='input_17' type='radio' value='No'  id='choice_4_17_1'    \/>\n\t\t\t\t<label for='choice_4_17_1' id='label_4_17_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_18\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_18\"><label class='gfield_label gform-field-label'  >Do you have flu-like symptoms?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_18'>Chills\/ Fatigue\/ Muscle aches\/ Headache\/ Vomiting\/ Diarrhea<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_18'>\n\t\t\t<li class='gchoice gchoice_4_18_0'>\n\t\t\t\t<input name='input_18' type='radio' value='Yes'  id='choice_4_18_0'    \/>\n\t\t\t\t<label for='choice_4_18_0' id='label_4_18_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_18_1'>\n\t\t\t\t<input name='input_18' type='radio' value='No'  id='choice_4_18_1'    \/>\n\t\t\t\t<label for='choice_4_18_1' id='label_4_18_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_19\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_19\"><label class='gfield_label gform-field-label'  >Do you have a runny nose?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_19'>\n\t\t\t<li class='gchoice gchoice_4_19_0'>\n\t\t\t\t<input name='input_19' type='radio' value='Yes'  id='choice_4_19_0'    \/>\n\t\t\t\t<label for='choice_4_19_0' id='label_4_19_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_19_1'>\n\t\t\t\t<input name='input_19' type='radio' value='No'  id='choice_4_19_1'    \/>\n\t\t\t\t<label for='choice_4_19_1' id='label_4_19_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_25\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_25\"><label class='gfield_label gform-field-label'  >Have you experienced recent loss of taste or smell?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_25'>\n\t\t\t<li class='gchoice gchoice_4_25_0'>\n\t\t\t\t<input name='input_25' type='radio' value='Yes'  id='choice_4_25_0'    \/>\n\t\t\t\t<label for='choice_4_25_0' id='label_4_25_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_25_1'>\n\t\t\t\t<input name='input_25' type='radio' value='No'  id='choice_4_25_1'    \/>\n\t\t\t\t<label for='choice_4_25_1' id='label_4_25_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_20\"  class=\"gfield gfield--type-section gsection form-section field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_20\"><h2 class=\"gsection_title\">High Risk Patients<\/h2><\/li><li id=\"field_4_21\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_21\"><label class='gfield_label gform-field-label' for='input_4_21' >I understand that there are categories of people who are considered to be at increased risk for severe illness from COVID-19. These include individuals who are 65 years of age and older, and patients who have been diagnosed with heart disease, pulmonary disorders, auto-immune disorders, diabetes, cancer, and kidney disease.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_21'>Initials Required<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_21' id='input_4_21' class='textarea small'  aria-describedby=\"gfield_description_4_21\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_4_28\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_28\"><label class='gfield_label gform-field-label' for='input_4_28' >I acknowledge that I fall into the above high risk categories. If needed, my dentist and I will discuss the risks prior to treatment.<\/label><div class='gfield_description' id='gfield_description_4_28'>Initials Required (IF APPLICABLE)<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_28' id='input_4_28' class='textarea small'  aria-describedby=\"gfield_description_4_28\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_4_31\"  class=\"gfield gfield--type-section gsection form-section field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_31\"><h2 class=\"gsection_title\">COVID-19 Testing<\/h2><\/li><li id=\"field_4_30\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_30\"><label class='gfield_label gform-field-label' for='input_4_30' >I confirm that to my knowledge, I am not currently positive for COVID-19.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_30'>Initials required<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_30' id='input_4_30' class='textarea small'  aria-describedby=\"gfield_description_4_30\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_4_32\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_32\"><label class='gfield_label gform-field-label' for='input_4_32' >I confirm that I am not waiting for the results of a laboratory test for COVID-19.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_32'>Initials Required<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_32' id='input_4_32' class='textarea small'  aria-describedby=\"gfield_description_4_32\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_4_33\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_33\"><label class='gfield_label gform-field-label' for='input_4_33' >I verify that I have not been identified as a contact of someone who has tested positive for COVID-19, or been asked to self-isolated by Alberta Health, the Communicable Disease Control, or any other governmental health agency.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_33'>Initials Required<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_33' id='input_4_33' class='textarea small'  aria-describedby=\"gfield_description_4_33\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_4_34\"  class=\"gfield gfield--type-section gsection form-section field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_4_34\"><h2 class=\"gsection_title\">CONSENT<\/h2><\/li><li id=\"field_4_36\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_36\"><label class='gfield_label gform-field-label' for='input_4_36' >I understand that Alberta Health Services has asked individuals to maintain physical distancing of at least 2 meters (6 feet) and it is not possible to maintain this distance while receiving dental treatment.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_36'>Initials Required<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_36' id='input_4_36' class='textarea small'  aria-describedby=\"gfield_description_4_36\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_4_37\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_37\"><label class='gfield_label gform-field-label' for='input_4_37' >I verify the information I have provided on this online form is truthful and accurate. I knowingly and willingly consent to receive dental treatment at Dr. David French&#039;s office.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_37'>Initials Required<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_37' id='input_4_37' class='textarea small'  aria-describedby=\"gfield_description_4_37\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_4_38\"  class=\"gfield gfield--type-captcha field_sublabel_below gfield--no-description field_description_below hidden_label gfield_visibility_visible\"  data-js-reload=\"field_4_38\"><label class='gfield_label gform-field-label' for='input_4_38' >CAPTCHA<\/label><div id='input_4_38' class='ginput_container ginput_recaptcha' data-sitekey='6LdJ1vYaAAAAAFZyjKDlg81QkIff_23CA06yP2RO'  data-theme='light' data-tabindex='-1' data-size='invisible' data-badge='bottomright'><\/div><\/li><\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_4' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_4\"]){return false;}  window[\"gf_submitting_4\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_4\"]){return false;} window[\"gf_submitting_4\"]=true;  jQuery(\"#gform_4\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_4' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='4' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_4' value='WyJbXSIsIjZiYmE4YTg1NWU4MzUzNDlkYTJhYjhkYjBkYmM3YTBmIl0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_4' id='gform_target_page_number_4' value='0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_4' id='gform_source_page_number_4' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 4, 'https:\/\/drdavidfrench.ca\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_4').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_4');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_4').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_4').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_4').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_4').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_4').val();gformInitSpinner( 4, 'https:\/\/drdavidfrench.ca\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [4, current_page]);window['gf_submitting_4'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_4').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [4]);window['gf_submitting_4'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_4').text());}, 50);}else{jQuery('#gform_4').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [4, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 4, currentPage: current_page } });} );} ); \n\/* ]]> *\/\n<\/script>\n\n","protected":false},"excerpt":{"rendered":"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 Date* MM slash DD slash YYYY Name*...","protected":false},"author":4,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/drdavidfrench.ca\/wp-json\/wp\/v2\/pages\/2121"}],"collection":[{"href":"https:\/\/drdavidfrench.ca\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/drdavidfrench.ca\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/drdavidfrench.ca\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/drdavidfrench.ca\/wp-json\/wp\/v2\/comments?post=2121"}],"version-history":[{"count":0,"href":"https:\/\/drdavidfrench.ca\/wp-json\/wp\/v2\/pages\/2121\/revisions"}],"wp:attachment":[{"href":"https:\/\/drdavidfrench.ca\/wp-json\/wp\/v2\/media?parent=2121"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}