COVID-19 Health Questionnaire | Riverside Orthodontics COVID-19 Health Questionnaire | Riverside Orthodontics
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1171 E. Putnam Ave. Building #2 Riverside, CT 06878
Complimentary Exam
New Patient Number: (203) 717-4740
Existing Patient Number: (203) 450-4969

COVID-19 Health Questionnaire and COVID-19 Informed Consent Forms

1171 E. Putnam Ave. Building #2
Riverside, CT 06878
(203) 698-0045
Complimentary Consultation!

Covid-19 Health

Download Covid-19 Consent Form

  • SUPPLEMENTAL

    HEALTH QUESTIONNAIRE

    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:
  • Do you, your child, others accompanying you to today’s appointment or anyone you have recently been in contact with have any of the following symptoms?

  • We can give you the smile you deserve

  • We can make you feel happier and more confident with a beautiful new smile

  • We can boost your image with a beautiful new smile

  • A better bite can make all the difference