In accordance with the Ontario Ministry of Health recommendations, please call or email to reschedule your appointment if you or any members of your household have any of the following symptoms:

1. Do you have concern for a potential Covid-19 infection? (e.g., Is there an outbreak in the facility or are you waiting for test results?)
2. Did the person travel outside of Canada in the past 14 days?
3. Has the person tested positive for Covid-19 or told they should be isolating?
4. Has the person had close contact with a confirmed case of Covid-19 without wearing the appropriate PPE?
5. Does the person have/had any of the following symptoms in the past 14 days?
   • Fever
   • New onset of cough
   • Worsening chronic cough
   • Shortness of breath
   • Difficulty breathing
   • Sore throat
   • Difficulty swallowing
   • Decrease or loss of sense of taste or smell
   • Headaches
   • Unexplained/Extreme fatigue/Malaise/Muscle aches (myalgias)
   • Gastrointestinal symptoms, nausea/Vomiting, Diarrhea, Abdominal pain
   • Pink eye (conjunctivitis)
   • Runny nose, or nasal congestion without other known cause
6. Has the person attended a gathering of more than the current allowed public health measure?
7. If person is 70 years of age or older, are they experiencing any of the following symptoms:
   • Delirium
   • Unexplained or increased number of falls
   • Acute functional decline
   • Worsening of a chronic conditions

We are following all public health guidelines set out by the Ontario Ministry of Health to prevent the spread of viruses. We take great pride in offering a safe environment for all our patients and staff, however there is always a potential risk of contacting Covid-19 in our setting. By replying to this questionnaire and attending your orthodontic appointment you acknowledge that you are aware, and assume these risks.

Please text us your name and reply Yes/No to these questions upon arrival to your appointment to start the check in process.