Dear Patients,

 

Please be aware that our office is taking all possible precautions for the safety of our patients and team during the COVID-19 pandemic including following recommendations of the CDC, Indiana State Dental Board, and the Indiana Department of Health. We ask that you please truthfully complete the following survey to assist us in maintaining the safest office environment possible. We also ask that you complete the consent portion of the form below.

 

Thank you for your cooperation in ensuring our office is as safe as possible.

 

Sincerely,

Dr. Daniel Klauer

Consent and Screening for Treatment During COVID-19 Pandemic

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