Have you, your child, or others accompanying you to today’s appointment been tested positive for or been diagnosed as having Covid-19?
If so, when?
Do you, your child, or others accompanying you to today’s appointment have:
Shortness of Breath and/or Trouble Breathing
Persistent pain, pressure or Tightness in the chest?
If any of you have any of these symptoms or have recently tested positive for or been diagnosed with Covid-19, you will be asked to reschedule your orthodontic appointment.
Do you acknowledge and accept the risk of exposure in our orthodontic office to a communicable disease, included but not limited to Covid-19, and consent to treatment?