COVID-19 Patient Forms

Checklist for Your Next Appointment

Before You Arrive

  • Fill out the COVID-19 supplemental informed consent document. This needs to be filled out once for every patient of record.
  • Next, fill out the COVID-19 screening form. This will have to be filled out prior to every visit.
  • Please bring any parts that were loose or broken to your appointment.
  • Please bring your removable appliances to your appointment.
  • Before you come, teeth must be brushed thoroughly, until the metal of your braces shines as we have temporarily closed the toothbrushing area. Please assure all plaque removal and floss before you arrive.


When You Arrive

  • Please arrive on site 10 minutes before your scheduled appointment and call our office to let us know you have arrived. We will call you when it is time to come in. For pediatric age patients, a single parent may come to the reception area.
  • Please leave other family members at home or in the car.
  • A facemask must be worn by everyone when entering the building.
  • Upon arrival, we will be taking your temperature. No one with a fever will be seen; you will be asked to leave immediately and encouraged to be seen by a healthcare provider for Covid-19 screening. Please help us by taking your temperature at home before you leave to prescreen yourself.
  • Every patient will be asked to rinse with a peroxide mouthwash before you are seen.


After Your Visit

Immediately following a child’s visit, the clinical assistant will call you to update patient progress, deliver a visit summary including a hygiene/homecare score and let you know if your child’s progress is on schedule.

Be prepared to schedule your next visit right then. Follow-up appointments will be scheduled 7-8 weeks out until we have accommodated all patients not seen during the pandemic quarantine.


Special Note

When you come for your appointment, you will find the reception areas looking rather sparse; seating has been removed for your safety and to keep people more than 6 feet apart. Some protocols have been changed for everyone’s safety and to maintain social distancing.

At this time, you will find that we cannot seat patients in every treatment chair. Fewer patients will be scheduled each day. For this reason, your next visit interval will be a bit longer than usual.

Virtual Exams

Our office may be closed physically, but we're still here for you virtually.