COVID-19 RISK INFORMED CONSENT

PLEASE READ CAREFULLY

Please read our new guidelinesĀ listed below:

At ourĀ MalahideĀ Clinic your safety is our priority. We want you to be familiar with our new protocols at the Clinic and know what to expect when youā€™re coming in for your appointments and treatments.Ā 

On entry we will ask you to wear a mask, use a handĀ sanitizerĀ & read + sign the treatment consent form (read below)

SYMPTOMS

If you have had any of the following symptoms or have been in close contact with anybody with any of the following symptoms within the last 14 days, please call the clinic and we will happily reschedule your appointment or treatment:

  • Fever
  • Chills or sweats
  • Cough
  • Shortness of breath
  • Headache
  • Sore throat
  • Aches and pains that are new
  • Generally feeling unwell
  • loss of smell and/or taste

APPOINTMENT TIMES

In order to reduce proximity between visitors to the clinic, we have devised timing protocols that will ensure distancing and improve safety for you. It is important to arrive at your scheduled appointment time. We kindly ask that you arrive at your appointment time and not earlier or later. If you think you will be more than 5 minutes late, please call the clinic prior to entering as your appointment may need to be rescheduled. Ideally you should give yourself plenty of time to arrive at the clinic, and if you are a few minutes early, either call the clinic to check if you can enter or wait until your exact appointment time.Ā 

VISITORS AND CHILDREN

Only people who have appointments scheduled should come to the clinic. Please do not arrive with friends, family members, or spouses, even if they too have appointments. Each person must arrive separately for their appointment. We regret that children are not permitted in the clinic until further notice.Ā 

MAKE-UP

If you are having a consultation for skin or face procedures, or are undergoing any facial or skin treatment, please do not wear makeup to the clinic. Make sure your skin is thoroughly cleansed prior to arriving. Please do not wear earrings or necklaces if you are undergoing treatments for the face or neck.

The use of the toilet in the clinic will not be permitted.

 

CONSENT FORM:Ā 

Ā  I understand that I am opting for an elective treatment/procedure that is not urgent and may not be medically necessary. I also understand that the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. I further understand that COVID-19 is extremely contagious and is believed to spread by person-to-person contact; and, as a result, the HSE recommend social distancing. I recognize that Perfect White Smiles is closely monitoring this situation and have put in place reasonable preventative measures aimed to reduce the spread of COVID-19. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 by virtue of proceeding with this elective treatment/procedure/surgery. I hereby acknowledge and assume the risk of becoming infected with COVID-19 through this elective treatment/procedure and I give my express permission for Perfect White Smiles to proceed with the same.

Ā  I understand that, even if I have been tested for COVID and received a negative test result, the tests in some cases may fail to detect the virus or I may have contracted COVID after the test. I understand that, if I have a COVID-19 infection, and even if I do not have any symptoms for the same, proceeding with this elective treatment/procedure/surgery can lead to a higher chance of complication and death. I understand that possible exposure to COVID-19 before/during/after my treatment/procedure may result in the following: a positive COVID-19 diagnosis, extended quarantine/self-isolation, additional tests, hospitalization that may require medical therapy, Intensive Care treatment, possible need for intubation/ventilator support, short-term or long-term intubation, other potential complications, and the risk of death. In addition, after my elective treatment/procedure, I may need additional care that may require me to go to an emergency room or a hospital.

Ā  I understand that COVID-19 may cause additional risks, some or many of which may not currently be known at this time, in addition to the risks described herein, as well as those risks for the treatment/procedure itself.
I have been given the option to defer my treatment/procedure to a later date. However, I understand all the potential risks, including but not limited to the potential short-term and long-term complications related to COVID-19, and I would like to proceed with my desired treatment/procedure.