COVID19 Consent Form

Please complete this form in full and send to us prior to turning up for your appointment.

    Orthodontic Treatment in the Era of COVID-19

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




    Patient/Parent’s Name

    Today's Date: