Wellness Screening

To our orthodontic family and friends, thank you for your support and patience in the past weeks as our office has been closed in compliance with our Governor’s directives during the peak of the COVID-19 pandemic. We are looking forward to resuming orthodontic care in the safest possible way for both our patients and staff. Part of that initiative includes the attached Wellness Screening to be returned PRIOR to EACH APPOINTMENT. Please call or email the office if you have any questions, and we will see you soon!


  • In the last 14 days, has the patient (or any member of the household) had any of the following?

  • Has the patient, a family member, or any known close contact had either of the following occur?
  • Date Format: MM slash DD slash YYYY