Treatment Consent: Dear patient, you have come to our office today for a routine dental evaluation and/or treatment that will be done during the Covid-19 pandemic. Please be advised on the following: While our office complies with State Health department and CDC guidelines to prevent the spread of Covid-19 virus we cannot make any guarantees. Our staff are symptom free and to the best of their knowledge have not been exposed to the Covid-19 virus. However since we are a place of public accommodation other patient could be infected with or without their knowledge. In order to reduce the risk of spreading Covid-19 we have asked you a number of "screening questions" above. For the safety of our staff, patients, and yourself please be truthful and candid in your answers. Clicking "YES" to the following question indicates that the risks involved in making an appointment are understood and accepted, as well as consent is given for treatment to be provided by Dr. Simons as well as her staff. *