Supplemental Health Questionnaire

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


    Do you, your child, or others accompanying you to today's appointment or other recent acquaintances have:

  • This field is for validation purposes and should be left unchanged.