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Covid Consent Form

I knowingly and willingly consent to have treatment completed during the COVID-19 pandemic at Ideal Pediatrics. I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not given the current limits in virus testing.

Shortness of Breath
Dry Cough
Runny Nose
Sore Throat
Watery Eyes, or Sinus Pain Headaches,
Fatigue or weakness
Loss of sense of taste or smell
Indicates signature and acknowledgment
* Required field