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All Staff Are Required to Complete This Consent Form Prior to Each Shift

COVID-19 Staff consent is required to ensure the health and safety of both our patients and staff during the COVID-19 pandemic. We require the submission of a COVID-19 staff consent form in order for patients and staff to attend appointments.

PLEASE COMPLETE THE COVID-19 STAFF CONSENT FORM BELOW:

*Required

CMOH Order 05-2020 legally obligates any person who has the following cough, fever, shortness of breath, runny nose, or sore throat (that is not related to a pre-existing illness or health condition) to be in isolation (quarantine) for 10 days from the start of symptoms, or until symptoms resolve, whichever takes longer. If they are exhibiting any of these symptoms, it is suggested they complete the COVID-19 Self-Assessment online tool to determine if they should be tested.

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Thank you for being an integral part of the Acora Dental Team!