Guideline and Patient Consent for Dental treatment During Covid-19 Pandemic

Guideline and Patient Consent for Dental Treatment During Covid-19 Pandemic

As BC health authorities are lifting some restrictions for dental offices during phase 2 of Covid-19 pandemic through BC , our office will resume providing more routine treatments with priority given to more urgent cases.

Following new guidelines set by BC health authorities, our office has established a new set of policies and measures to provide a safe environment for our staff and our patients while providing dental treatment. We go beyond the mandates set by authorities to minimize the risk of any transmission while you are visiting our office. This includes installation of transparent barriers in reception area, modification of schedule system to minimize the amount of person to person contact, use of dental barriers to reduce or eliminate the aerosol spread at the source during aerosol generation procedures, use of powerful extra oral high volume evacuators with HEPA filter as well as air purifier equipped with HEPA filter and UVC light. Our new policy also reduce the amount of contact between patient to patient and patient with staff.

To ensure everybody’s safety, please read and follow the following instruction in detail.


Please follow the step by step instruction;

1- Brush AND floss your teeth at home or work before coming to our office and do not eat after brushing and flossing.

2- Have your face mask on, if you use any, when you come to your dental visit.

3-When arriving, please do NOT enter the office. You may stay in your car if you are driving and call us to let us know you have been arrived or come inside the Mall and use the chair outside our office on the left side of office entrance. The staff will let you know when to enter the office. Please keep a minimum distance of 6 feet from staff and other visitors.

4- We provide a mouthwash. Please wash your hand in outside bathroom and rinse and gurgle with mouth wash for one minute and release it slowly to the sink. Please dispose the cup in the garbage and wash your hand, put on the face mask if available, and come back to outside seat.

5- One of our staff will measure your temprature using touch less thermometer and take you directly to the dental operatory room. We regret we can not allow any family member or friend to accompany you inside office UNLESS in the cases of children or people who need assistant by a family member.

6- We will try to accommodate as much as treatment needed on any single visit to reduce the number of visits per person.

7- Upon completion of your treatment, please do not leave the chair until one of our staff guides you to the outside.

8- To minimize you spending time in reception area, we do our best to complete all administrative works such as billing insurance company, if applicable and postings before you would be guided to outside. We attempt to do the billing matters using touch less machine or in case you are paying by credit card, you can provide the number to the receptionist in order to be entered in to the machine.

9- Any paperwork such as receipts can be email to you at your request.

As per guideline, each patient for each dental visit should acknowledge and consent to receive dental treatment and to confirm that they do not have any signs and symptoms of Covid-19. Please read the following form and acknowledge and consent to your upcoming treatment within 24 hours of your appointment to keep your appointment in place.


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 of the virus may not show symptoms and still be contagious.

I understand that dental procedures create water spray which is one way that the novel coronavirus can spread. The ultra-fine nature of the spray can linger in the air for minutes to sometimes hours, which can transmit the novel coronavirus.

I understand that due to the frequency of visits of other dental patients, the characteristics of the novel coronavirus, and the characteristics of dental procedures, that I have an elevated risk of contracting the novel coronavirus simply by being in a dental office.

I confirm that I am not presenting any of the following symptoms of COVID-19:
• Fever > 37.5 C
• Cough
• Sore Throat
• Shortness of Breath
• Flu-like symptoms

I confirm that I am not currently positive for the novel coronavirus.

I confirm that I am not waiting for the results of a laboratory test for the novel coronavirus.

I verify that I have not returned to British Columbia from any country or any other provinces in Canada whether by car, air, bus or train in the past 14 days.

I understand that any travel from outside of British Columbia, including travel by car, air, bus or train, significantly increases my risk of contracting and transmitting the novel coronavirus. BC’s Provincial Health Officer requires self-isolation for 14 days from the date a person has returned to Canada.

I understand that BC’s Provincial Health Officer has asked individuals to maintain social distancing of at least 2 metres (6 feet) and it is not possible to maintain this distance and receive dental treatment.

I verify that I have not been identified as a contact of someone who has tested positive for novel Corona virus or been asked to self-isolate by BC’s Provincial Health Officer, the Communicable Disease Control or any other governmental health agency.

Please do NOT send this consent form IF you have any doubt that you might be suspicious to have any type of flu OR you might be at high risk. In this case call our office immediately for instruction.