AAOIC SUPPLEMENTAL HEALTH QUESTIONNAIRE
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:
Have you, your child, or anyone in your family traveled outside of the state in the last 30 days?
Have you, your child, or others accompanying you to today’s appointment or other recent acquaintances tested positive for or been diagnosed as having COVID-19 or any other communicable disease?
Do you, your child, or others accompanying you to today’s appointment or other recent acquaintances have:
I understand that if the answer to any of these questions is yes, I will be asked to reschedule today’s orthodontic appointment.