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baby and rojas orthodontics

COVID-19 Screening Questionnaire

Please fill out this form upon receipt. We must have the answers to these COVID questions before confirming your appointment.

ALL PUBLIC WASHROOMS ARE CLOSED Please be sure to use facilities BEFORE coming to your appointment.

BRUSH YOUR TEETH BEFORE YOUR APPOINTMENT If the mouth is very dirty, we may need to reschedule your appointment

ONLY PATIENTS ARE ALLOWED TO ENTER THE LOCKED BUILDING

ALL PATIENT MUST BE WEARING A MASK, SCARF OR CLOTH OVER THEIR NOSE AND MOUTH TO ENTER Because of the lack of PPE, masks will NOT be supplied by our office. You must have a mask or covering to enter.

ALL PAYMENTS CAN BE DONE VIA ETRANSFER OR CREDIT CARD PRIOR TO APPOINTMENT

  • Do you have any of the following symptoms:

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