consent to receive elective aesthetic procedures from Aesthetic Revolution Las Vegas during the COVID-19 outbreak.
I understand there is much to learn about who the COVID-19 virus spreads and is transmitted.
I understand that based on what is currently known about COVID-19 the spread is thought to occur mostly from person-to-person via respiratory droplets among close contacts. I understand that close contact can occur from being within approximately 6 feet of someone with COVID-19 for a prolonged period of time or by having direct contact with infectious secretions from someone with COVID-19
I understand that carriers of COVID-19 may not show symptoms but may still be highly contagious.
I understand that due to the unknowns of this virus, the number of other patients that have been in the practice and the nature of the procedures performed here, that I have an increased risk of contracting the virus by being in the practice and by receiving treatment in the practice.
I understand that under the CDC guidelines, do not recommend proceeding with any treatment that is non-essential at this time.
I understand that the treatment I am receiving is NOT a medical emergency. It is an elective treatment.
I understand that dental procedures have the potential to include aerosol-generating procedures as well as anticipated splashes and sprays, which are some of the ways that COVID-19 can be spread.
I understand that the symptoms listed below are representative of COVID-19:
I confirm that I do not display or currently have any of the symptoms that are representative of COVID- 19, which are outlined above: (Initial)
I understand that all travelers arriving from a country or region with widespread ongoing transmission, as outlined by the CDC, should stay home for 14 days to practice social distancing and monitor their health after their arrival.
I confirm that I have not traveled to any of the countries or regions with widespread ongoing transmission (Level 3 Travel Health Notice) in the past 14 days
I confirm, to the best of my knowledge, that I have not had close contact with an individual diagnosed with COVID-19 in the past 14 days.