The novel Corona virus, 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. Our office (Dental Practice/ Nikaeen Orthodontics) has put in place comprehensive preventative measures and expended significant sums of money to purchase sophisticated equipment to reduce the spread of COVID-19 and to assure each Patient that their risk of contracting COVID-19 is minimal; however, Nikaeen Orthodontics cannot guarantee that you will not become infected with COVID-19 while receiving care at our dental practice.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I or the patient may be exposed to or infected by COVID-19 at Nikaeen orthodontics during my or patient treatment or visit. I understand that the risk of becoming exposed to, or infected by COVID-19 at Nikaeen Orthodontics may result from the actions, omissions, or negligence of myself and others, including, but not limited to, dental practice employees and other patients.
I voluntarily agree o assume all of the foregoing risks and accept sole responsibility for any injury to me or patient (including, but not limited to, personal injury, disability, and death) that I/we may experience or incur in connection with my appointment with or treatment at the Dental Practice.
I hereby release,, covenant not to sue, discharge, and hold harmless the Dental Practice, its employees, agents, and representatives, and other patients of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating there to.
I understand, and agree that this release includes any Claims based on the actions, omissions, or negligence of the Dental Practice, its employees, agents, representatives and other patients.