COVID‐19 PANDEMIC PATIENT DISCLOSURES FORM
Please Wear a Mask
Everyone entering the office must wear a mask or face covering that covers their nose and mouth. Please enter the office when you arrive. Curbside check-in is no longer offered.
Health Screening Upon Arrival
We’ll take your temperature as soon as you enter our office. We’ll also ask you to complete a health screening questionnaire before starting your appointment. If you answer “yes” to any question on the questionnaire, we may ask you to reschedule your appointment.
Hand Sanitizer
We’ll have hand sanitizer set up at the consent signing area (formerly our coffee bar). Please use upon entering.
No Extra People in the office
We ask that you attend your appointment alone, but will provide accommodations for young patients or patients with special needs/considerations. Older patients should attend their appointments alone if possible. Parents who accompany their child will be asked to come into the treatment area, instead of waiting in the reception area.
Special Procedures for Children’s Appointments (under 19 years old)
If you are bringing a minor (someone under 19 years old) to an appointment, we will ask you to briefly come into the office twice. After staff have notified you that we are ready for you to enter the office, please accompany your child inside to give consents and update medical history. At the end of the appointment, staff will contact you to again come inside and discuss your child’s treatment directly with Dr. Steckelberg.
Brush Your Teeth Before You Arrive
Our tooth brushing station will be closed, so make sure your teeth are sparkling clean before you come.
Mouthguard, Dentures, and Partials
We are not able to provide our regular ultrasonic cleaning of your mouthguard, dentures, or partials during your appointment. Please ask us about options for getting these dental appliances as clean as possible at home.
Reschedule If You are Sick
Please reschedule your appointment if you are experiencing any of the following symptoms.
- Fever of 100 degrees F or greater
- New Cough
- New Shortness of breath or difficulty breathing
- Repeated shaking and/or chills
- New Body Aches
- New Sore throat
- New loss of taste or smell
Reschedule If You have been Exposed or are Isolating
Please reschedule your appointment if you, or anyone in your household fits any one of these scenarios:
- Is Quarantining at home, after being exposed to someone who tested positive for COVID-19 within the past 14 days
- Is Quarantining/Isolating at home, based on medical directive
- Has tested positive for COVID-19 within the past 14 days
Please contact your physician or local health department for specific questions about your exposure risk, when to quarantine or isolate, when to get tested, or any questions about COVID-19.