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Orthodontic Treatment in the Era of Communicable Diseases (ie: Covid & Influenza)

Thank you for your continued trust in our practice. As with the transmission of any communicable disease like a cold or the flu, you may be exposed to COVID-19, also known as “Coronavirus” at any time or in any place. Be assured that we have always followed provincial and federal regulations and recommended universal personal protection and disinfection protocols to limit transmission of all diseases in our office and continue to do so.

Despite our careful attention to sterilization, disinfection, use of personal barriers, and isolated treatment areas, there is still a chance that you could be exposed to an illness in our office. “Physical Distancing” has reduced the transmission of the Coronavirus. Although we have taken measures to provide physical distancing in our practice, due to the nature of the procedures we provide, it is not possible to maintain physical distancing between the patient, orthodontist, orthodontic staff and sometimes other patients at all times.

Please read and acknowledge by your initial in all areas indicated. If you have any questions please do not hesitate to contact our office.

Although exposure is unlikely, do you accept the risk and knowingly and willingly consent to have orthodontic treatment for yourself or your child completed during the COVID-19 pandemic?please choose one

Patient Signature: By initialing each box above and typing out your name below you acknowledge that you understand the risks affiliated with visiting the dentist during a pandemic and acknowledge that you will adhere to all of our office rules and that you are not experiencing any symptoms and are not required to be quarantined.

Adapted from BC Dental Association COVID-19 Pandemic Guidelines (as of May 22, 2020)

 Dr. Angelina Y.C. Loo, Inc./ Dr. Edwin H.K. Yen

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