If you have been exposed to a communicable disease prior to your orthodontic appointment, you may spread the disease to the orthodontist, orthodontic staff and to other patients/parents in the practice. Therefore, prior to each appointment, we require you to answer the following questions:
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:
A Fever (defined as above 99.6 degrees)
Shortness of Breath and/or Trouble Breathing
Persistent pain, pressure or Tightness in the chest?
Have you experienced loss of taste or smell?
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.
Patient/Responsible Party Signature