Our Patients

Name: Downtown Orthodontics
Address: 820 3rd Ave S, Lethbridge, AB, T1J 0H7, Canada
Telephone: 403-380-4444

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.

Patient Name*

I UNDERSTAND THE NOVEL CORONAVIRUS CAUSES THE DISEASE KNOWN AS COVID-19. I UNDERSTAND THE NOVEL CORONAVIRUS VIRUS HAS A LONG INCUBATION PERIOD DURING WHICH THE CARRIER OF THE VIRUS MAY NOT SHOW SYMPTOMS AND STILL BE CONTAGIOUS. Please answer "Yes" or "No".*

I UNDERSTAND THAT DUE TO THE FREQUENCY OF VISITS OF OTHER DENTAL PATIENTS, THE CHARACTERISTICS OF THE NOVEL CORONAVIRUS, AND OTHER CHARACTERISTICS OF DENTAL PROCEDURES, THAT I HAVE AN ELEVATED RISK OF CONTRACTING THE NOVEL CORONAVIRUS SIMPLY BY BEING IN A DENTAL OFFICE. Please answer "Yes" or "No".*

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

FEVER OF MORE THAN 38 CELSIUS. Please answer "Yes" or "No".:*

NEW COUGH OR WORSENING CHRONIC COUGH. Please answer "Yes" or "No".:*

SORE THROAT OR PAINFUL SWALLOWING. Please answer "Yes" or "No".:*

NEW OR WORSENING SHORTNESS OR BREATH. Please answer "Yes" or "No".:*

DIFFICULTY BREATHING. Please answer "Yes" or "No".:*

FLU LIKE SYMPTOMS. Please answer "Yes" or "No".:*

RUNNY NOSE. Please answer "Yes" or "No".:*

I CONFIRM THAT I KNOW THAT THERE ARE CATEGORIES OF PEOPLE WHO ARE CONSIDERED TO BE HIGH RISK. I UNDERSTAND THE HIGH RISK CATEGORY FACTORS ARE BEING 65 YEARS OF AGE OR OLDER, HEART DISEASE, LONG DISEASE, KIDNEY DISEASE, DIABETES OR ANY AUTO-IMMUNE DISORDER. Please answer "Yes" or "No".*

I FALL INTO THE FOLLOWING HIGH RISK CATEGORIES

AND MY DENTIST AND I HAVE DISCUSSED THE RISKS, AND I HAVE AGREED TO PROCEED WITH TREATMENT. Please answer "Yes" or "No".*

I CONFIRM THAT TO MY KNOWLEDGE I AM NOT CURRENTLY POSITIVE FOR THE NOVEL CORONAVIRUS. Please answer "Yes" or "No".*

I CONFIRM THAT I AM NOT WAITING FOR RESULTS OF A LABORATORY TEST FOR NOVEL CORONAVIRUS THAT WAS ORDERED DUE TO CONTRACT TRACING OR BECAUSE I HAD IDENTIFIED RISK FACTORS. Please answer "Yes" or "No".*

I VERIFY THAT I HAVE NOT RETURNED FROM ALBERTA FROM ANY COUNTRY OUTSIDE OF CANADA WHETHER BY CAR, AIR, BUS, BOAT OR TRAIN IN THE PAST 14 DAYS. Please answer "Yes" or "No".*

I UNDERSTAND THAT ANY TRAVEL FROM ANY COUNTRY OUTSIDE OF CANADA, INCLUDING TRAVEL BY CAR, AIR, BUS, BOAT OR TRAIN, SIGNIFICANTLY INCREASES MY RISK OF CONTRACTING AND TRANSMITTING THE NOVEL CORONAVIRUS. ALBERTA HEALTH SERVICES REQUIRES SELF-ISOLATION FROM 14 DAYS FROM THE DATE A PERSON HAS RETURNED TO CANADA. Please answer "Yes" or "No".*

I UNDERSTAND THAT ALBERTA HEALTH SERVICES HAS ASKED INDIVIDUALS TO MAINTAIN PHYSICAL DISTANCING OF AT LEAST 2 METERS (6 FT) AND IT'S NOT POSSIBLE TO MAINTAIN THIS DISTANCE AND RECEIVE DENTAL TREATMENT. Please answer "Yes" or "No".*

I VERIFY THAT I HAVE NOT BEEN IDENTIFIED AS A CONTACT OF SOMEONE WHO HAS TESTED POSITIVE FOR NOVEL CORONAVIRUS OR BEEN ASKED TO SELF-ISOLATE BY ALBERTA HEALTH, THE COMMUNICABLE DISEASE CONTROL OR ANY OTHER GOVERNMENT HEALTH AGENCY. Please answer "Yes" or "No".*

I VERIFY THAT I AM A HEALTHCARE WORKER THAT HAS WORN APPROPRIATE PPE. Please answer "Yes" or "No".*

Name :

Date:

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.

Patient Forms

New Patient
Braces Care
Retainer Care
Bionator Care
Emergency

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Our Patients

COVID-19 PANDEMIC DENTAL TREATMENT CONSENT FORM

PATIENT HISTORY FORM

Children