1. Must be signed and returned only once by the patient or parent/guardian if the patient is under 21 years of age
COVID-19 Supplemental Informed Consent
2. Must be signed and returned AT EACH APPOINTMENT by the patient or parent/guardian if the patient is under 21 years of age
COVID-19 Supplemental Health Questionnaire
Thinking about improving your smile?
Just fill out this simple form and our team will set you up with a free consultation with Dr. Dayan!
Read a Personal Message Regarding COVID-19 from Dr. Dayan.
What To Do Before You Arrive:
–Electronically sign your COVID-19 consent forms by clicking the links above.
-Brush your teeth at home. Our toothbrush station and bathroom will be closed as per CDC, American Dental Association, and American Association of Orthodontists guidelines in order to mitigate aerosolization and cross-contamination.
-Please be on time to your appointment. If you are late, you may be asked to reschedule in order to minimize the amount of patients in the office.
-When you arrive, your temperature will be taken. If you have a fever, you will be asked to reschedule. Anyone presenting to the office who is sick will not be seen and will be asked to reschedule.
-After you check in, you will be asked to wait outside until we are ready to seat you in the operatory. The reception area/waiting room will be closed. Limiting the number of people inside the office keeps us all safer.
-We ask that all family members wait outside the office while their child is being treated. For adult patients we ask that you please come to the office alone. Only those who are actively being seen for treatment will be allowed in the treatment area.
-If a parent is needed at the front desk, we will ask your child to bring you in.
Thank you. If you have any questions, please contact the office.