rhinogram logo

AAO’s COVID-19 Consent Form and
Supplemental Health Questionnaire

You can use Right Signature (www.rightsignature.com) to create these forms within their software and email them to patients/responsible parties to digitally complete and sign prior to every appointment.

This form is an addendum to the office’s consent to treatment HIPAA form. It states that despite careful attention to sterilization, disinfection, proper use of PPE… etc., although exposure is unlikely there is still a risk.

AAOIC SUPPLEMENTAL INFORMED CONSENT

This questionnaire is used to help reduce the transmission of COVID-19 and any communicable disease.

SUPPLEMENTAL HEALTH QUESTIONNAIRE