COVID-19 Health & Safety Update

COVID-19 Waiver Consent Form

Dear Patient:

We hope this letter finds you and your family in good health. Our community has been through a lot over the last few months, and all of us are looking forward to resuming our normal habits and routines. While many things have changed, one thing has remained the same: our commitment to your safety.

Infection control has always been a top priority for our practice and you may have seen this during your visits to our office. Our infection control processes are made so that when you receive care, it’s both safe and comfortable. We want to tell you about the infection control procedures we follow in our practice to keep patients and staff safe.

Our office follows infection control recommendations made by the American Dental Association (ADA), the U.S. Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA). We follow the activities of these agencies so that we are up-to-date on any new rulings or guidance that may be issued.

You may see some changes when it is time for your next appointment. We made these changes to help protect our patients and staff. For example:

  • Appointments will be managed to allow for social distancing between patients. That might mean that you’re offered fewer options for scheduling your appointment.
  • We will do our best to allow greater time between patients to reduce waiting times for you, as well as to reduce the number of patients in the reception area at any one time. Since there will be less patients, kindly let us know in advance if you are not able to keep this time reserved for you. We still reserve the right to charge for broken appointments without at least 24 hours advanced notice.
  • Our office will communicate with you beforehand to ask some screening questions. You’ll be asked those same questions again when you are in the office. We will ask if you have/had any COVID-19 symptoms like fever, coughing, shortness of breath, loss of taste/smell, tested positive, recently traveled outside of CA, been exposed or have/had contact with someone with the virus.
  • Only one patient/family in the reception area is allowed, so in case you arrive early, we will ask you to wait in your car or outside the office. The secretary will advise you when you can go inside.
  • A mask is required to be worn before you enter and while in the office. We will let you know when to remove and put it back on.
  • Your temperature will be taken and recorded in our Daily Screening Log; ask you the same pre-screening questions again.
  • Ask you to use the hand sanitizer then wear these provided gloves while in the office. Sanitizing stations are located in the reception, front office and 3rd treatment room. Hand sanitizing soaps are located in various sinks and in the restroom.
  • The assistant will take you to the treatment room, instruct you when to remove your mask, for pre-rinsing, ask about any changes to your health info, then Dr. Sicam will proceed to the treatment scheduled.
  • After your treatment, post rinsing, remove and dispose the gloves in trash can provided, use the hand sanitizer again before exiting the office.
  • It is very important and we ask that you report to us if you should feel later any COVID-19 symptoms, this is for contact tracing.

We look forward to seeing you again and are happy to answer any questions you may have about the steps we take to keep you, and every patient, safe in our practice. To make an appointment, please call our office at 510-357-8960 or visit our website at

Thank you for being our patient. We value your trust and loyalty and look to welcoming back our patients, neighbors and friends.

Dr. Loreto R. Sicam, Jr.