Dr. Navneet Rai
433 Mount Prospect Ave, Newark, NJ 07104
COVID-19 Patient Prescreening & Consent Form
If positive, were you any of the following?
Please check the following regarding recent gatherings.
Please give details below such as date, number of people and any other important information. This information is to help us keep our
patients safe as well as our staff.
SUPPLEMENTAL INFORMED CONSENT:
Dental Treatment in the Era of COVID-19 Patient
Thank you for your continued trust in our practice. As with the transmission of any communicable disease like a cold or the flu, you may be exposed to COVID-19, also known as "Coronavirus," at any time or in any place. Be assured that we have always followed state and federal regulations and recommended universal personal protection protective equipment (PPE) and disinfection protocols to limit transmission of all diseases in our office and continue to do so.
Despite our careful attention to sterilization, disinfection, and use of personal barriers, there is still a chance that you could be exposed to an illness in our office, just as you might be at your gym, grocery store, or favorite restaurant. "Social Distancing" nationwide has reduced the transmission of the Coronavirus. Although we have taken measures to provide social distancing in our practice, due to the nature of the procedures we provide, it is not possible to maintain social distancing Between the patient, dental healthcare team members and sometimes other patients at all times.
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