COVID-19 Screening Form

We will be asking you to confirm answers to the following questions to reduce the chances of transmission of COVID-19 in our practice and the community. If you answer “Yes” to any of the Screening Questions below, you will be asked to reschedule your next orthodontic appointment to a later date. You may also download the Screening Form to complete at your leisure.

Also, please be prepared for the following changes when you arrive to our office:

• Please brush your teeth prior to coming to the office. We are not allowing patients to brush inside the clinic.
• Please arrive on time, but no earlier than 10 minutes before your appointment
• Please stay in your car and text the office to let us know that you have arrived. Our new text-only number is (289) 221-0518
• Only the patient is to enter the office at this time to limit the number of people in the clinic. Arrangements can be made if you do not feel comfortable with this.

When entering the office, please be prepared to:

1. Wear a mask or face-covering that can cover you nose and mouth into the office. Do not wear gloves.
2. Wash your hands immediately when entering.
3. Reconfirm the same screening questions.
4. Have your temperature taken with a non-touch forehead thermometer.