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Our Patients

Downtown Orthodontics sees patients of all ages – from children to adults. If you think you or your child could benefit from orthodontic treatment, it’s never too late to correct your bite. Contact us today for more information.

COVID-19 PANDEMIC DENTAL TREATMENT CONSENT FORM

To ensure the health and safety of both our patients and staff during the COVID-19 pandemic, all patients are required to review and submit a consent form prior to coming in for their next dental appointment.

I CONFIRM THAT I AM NOT PRESENTING ANY OF THE FOLLOWING SYMPTOMS OF COVID-19 IDENTIFIED BY ALBERTA HEALTH SERVICES:*:

OR

OR

PATIENT HISTORY FORM

Please complete this form as a new patient to Downtown Orthodontics as requested by the office or doctor.

This form is being reviewed and submitted by:

Male
Female

Name of Parent or Guardian (if applicable):

Married
Common Law
Separated
Divorced
Single
Widowed

Telephone:

Medical History

YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO

12. FEMALES ONLY:

YES
NO
YES
NO
YES
NO
aspirin
local anaesthetics
foods
penicillin
heart trouble
tuberculosis
anemia/blood disease
cancer
HIV/AIDS
rheumatic fever
mononucleosis
growth or tumour
heart murmur
blood transfusion
persistent cough
thyroid disease
diabetes
epilepsy
abnormal blood pressure
IV drug use
asthma
mental disease
arthritis
hepatitis
sexually transmitted disease
persistent diarrhea
persistent skin rash

Dental History

YES
NO
YES
NO
YES
NO
YES
NO
Yes
No
Not sure
Yes
No
Not sure
Yes
No
Yes
No

Parental/Guardian Consent

do hereby authorize Dr. Darren Tkach to perform an examination to determine the need for possible orthodontic treatment. As the patient is a minor, I hereby sign on his/her behalf as legal guardian. I authorize Dr. Darren Tkach to discuss aspects of the oral health of the aforementioned patient, or other relevant health information with other health care professionals I have seen (e.g. MD, DDS). I hereby confirm that, to the best of my knowledge, the above information is accurate and correct.

Children

Children who still have some baby teeth may require orthodontic treatment for the correction of specific problems. These problems may include the following:

  • Correction of a habit such as thumb sucking, which can move teeth and affect the bite
  • Early treatment to address severe developing crowding
  • The correction of tooth interferences like cross-bites, which may damage permanent teeth and affect bite development
  • The correction of growth-related problems in the upper or lower jaw

Teenagers

Most commonly, teenagers will wear braces to correct many types of problems. Often people will assume that the orthodontist simply straightens the teeth to improve the appearance of the patient’s smile. This is only part of the story. A corrected bite is also important to allow proper chewing, to minimize abnormal tooth wear, to ensure balanced jaw and muscle function, and to ensure the greatest ease when brushing and flossing the teeth.

Adults 

Adults can also benefit from the many advantages of orthodontic treatment. Even if some tooth wear or damage has occurred, adjusting the position and shape of teeth can restore their appearance and function. Orthodontic treatment can also make it easier to replace missing teeth with implants after the braces are gone.

Information

Downtown Orthodontics

820 3rd Ave S

Lethbridge, AB Canada

T1J 0H7

Phone: 403-380-4444

Fax: 403-380-4451

Email: info@downtownorthodontics.com

Hours

Monday: 7:45 AM - 4:15 PM
Tuesday: 8:30 AM – 4:45 PM
Wednesday: 7:45 AM - 4:15 PM
Thursday: 8:30 AM – 4:45 PM
Friday: 7:45 AM - 4:15 PM
Saturday & Sunday: Closed

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