Assumption of the Risk and Waiver of Liability Relating
to Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.
Happy Tooth has put in place preventative measures to reduce the spread of COVID-19; however, we cannot guarantee that pateints will not become infected with COVID-19. Further, attending our office could increase the patient's risk contracting COVID- 19.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by attending dental appointments at this office and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Happy Tooth may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Happy Tooth employees, and other patients and their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsilibity for any injury to myself (including, but not limited to personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with attending dental appointments at Happy Tooth. On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless at Happy Tooth, its employees, agents, representatives, of and from Happy Tooth, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or related thereto. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of Happy Tooth, its employees, agrents and representatives, whether a COVID-19 infection occurs before, during, or after participation in any type of dental appointment or visit.