For Patients

Health Questionnaire

If you have been exposed to a communicable disease, you may spread the disease to the orthodontist, orthodontic staff, or other patients/parents in the practice. Therefore, prior to each appointment, we will be asking the following questions to reduce the chances of transmission:

Health Questionnaire

Do you, your child, others accompanying you to today’s appointment or anyone you have recently been in contact with have any of the following symptoms?

Fever (defined as above 99.6 degrees)?
Cough?
Shortness of breath and/or trouble breathing?
Persistent pain, pressure, or tightness in the chest?

Have you, your child, others accompanying you to today’s appointment or anyone you have recently been in contact with tested positive for or been diagnosed as having COVID-19 or any other communicable disease?

Contact with anyone?
Please Confirm - I understand that if the answer to any of these questions is yes, I may be asked to reschedule today’s orthodontic appointment to a later date.

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Viva Orthodontics Locations

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Clayton Heights

Suite 107
6758 188th Street
Surrey, BC

778-574-8484

Coquitlam

Suite 640
2755 Lougheed Highway
Port Coquitlam, BC

604-552-3899

New Westminster

612 Belmont St
New Westminster, BC

604-522-9871

South Surrey

Suite 225
2411 160th Street
Surrey, BC

604-385-0805