(insert minor patient's name, if applicable), knowingly and willingly consent to have emergency dental treatment completed during the COVID-19 pandemic.
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. It is currently impracticable to determine who may have COVID-19 and not yet be exhibiting symptoms.
I further understand that dental procedures create water spray which may be one source for transmission of the virus. The ultra-fine nature of the spray can linger in the air from several minutes to sometimes hours, which can cause transmittal of the COVID-19 virus.