COVID-19 Health Questionnaire

If you have been exposed to a communicable disease, you may spread the disease to the orthodontic staff or other patients/parents in the practice. Therefore, prior to each appointment, we will be asking the following questions in order to reduce the chance of COVID-19 transmission. 

Do you, your child, or anyone you have recently been in contact with have (or had within the past 14 days) any of the following symptoms? 

1) Fever of high temperature (above 99.6 degrees)

2) Sore throat, cough, or shortness of breath (trouble breathing)

3) GI symptoms (e.g. diarrhea or nausea) or muscle fatigue

4) Loss of taste or sense of smell

5) Travelled domestically by air/bus/train or outside the USA

6) Tested positive for COVID-19 or are waiting COVID-19 test results

7) Have any underlying health issues (with compromised immune system) Including, but not limited to: diabetes, asthma, COPD, cancer treatment, radiation, chemotherapy, and/ any prior or current disease or medical condition.

Please be aware that if the answer to any of these questions is yes, you may be asked to reschedule your orthodontic appointment to a later date.