COVID-19 Office Procedures and Consent

Please read thoroughly, confirming your appointment acknowledges that you have read/understand this information and new procedures and also gives your consent to orthodontic treatment as described.

Our community has been through a lot over the past few months, and we know that we are all looking forward to resuming our normal routines. Throughout our temporary office closure, our practice has been working to stay in touch with you to ensure a smooth transition back to practice. The health and safety of our patients, team, and community have always been and continue to be our #1 priority. We have been closely monitoring all of the most current recommendations of how to keep our patients safe as we return to our in-office visits. These measures take into account all of the latest recommendations from the governing bodies and take physical distancing into account in order to minimize the number of people in our office at any one time, as well as person-to-person contact.

Please fill out the following two forms before arriving for your appointment

COVID-19 Informed Consent

COVID-19 Health Questionnaire


  1. Upon arrival to building, please text with patient’s name to 530-587-5582 to let us know that you are outside, and we will let you know when the patient can come inside the building. Please arrive 5 minutes before your appointment time. LATE ARRIVALS WILL BE ASKED TO RESCHEDULE.  
  2. Only the patient that is being treated will be allowed to enter the office. The only exception for this will be for our patients under the age of 18.  Of those, only one parent/caregiver may accompany the patient.  Absolutely no other family members or friends will be allowed inside.
  3. Please bring your own mask and wear it to your appointment. California health guidelines for social distancing and wearing masks in businesses continue, so bring the mask you have been using. We will have a limited supply of masks available for those who do not have one. 
  4. Our tooth-brushing station will now be used as a handwashing/sanitizing station and is required of every patient before being seated.  Please brush your teeth before you leave home, not in our bathroom facility. 
  5. We will also ask you to rinse with an antimicrobial peroxide rinse that we will provide, prior to being seated. Once seated, we will be taking each patient’s temperature, as well as their guardian, if present.
  6. We will schedule the next appointment for each patient before they leave, or are also happy to schedule later by phone.  Appointments will be managed to allow for social distancing between patients. This might mean fewer options for scheduling your appointment. Please understand that your next appointment may be scheduled out at a farther date than usual, due to the number of rescheduled and cancelled appointments we need to accommodate for.
  7. Walk-in appointments are not allowed, and all appointments must be confirmed ahead of time. By confirming your appointment, you are acknowledging your consent to the following:


  • I understand that the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not, given the current limits in virus testing.
  • Dental procedures create water spray. It is unclear as to how long the ultra-fine nature of the spray may linger in the air, which can transmit the COVID-19 virus.
  • I understand that the CDC recommends social distancing of at least 6 feet, and this is not possible with dentistry.
  • I confirm that I/the patient/household members am/are not presenting any of the following symptoms of COVID-19 listed below: fever, shortness of breath, dry cough, runny nose, sore throat, body aches, diarrhea and/or vomiting, loss of sense of taste/smell.
  • I verify that I/the patient/household members have not traveled outside the United States or domestically within the United States by commercial airline within the past 14 days.

We thank all of you for your support during this time. 

 Our practice would not exist without our amazing patients, and we are so grateful for each and every one of you! 

If you have any questions for us, please call 530-587-5582.

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