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:

  • 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?

  • 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?

    If yes provide approximate dates of illness below
    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.
  • This field is for validation purposes and should be left unchanged.
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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