​​​​​​Tel: 604-271-8833
info@blundellorthodontics.ca
 Blundell   Orthodontics ​​

2) COVID -19 Medical History Screening Form

Covid-19 symptoms are similar to other respiratory illnesses, including the flu and the common cold.


Please complete the form below and press submit. 

Each patient (or guardian) MUST READ and complete the two forms below, prior to your appointment in our clinic.

Either submit here online (no more than 24 hours before your appointment)  or complete in paper format in the clinic.


1)  COVID-19 Patient Consent for Care Form


Supplemental Informed Consent for Orthodontic Treatment in the Era of Covid-19

Thank you for your continued trust in our practice. As with the transmission of any communicable disease like a cold or the flu, you may be exposed to COVID-19 also known as “Coronavirus”, at any time or in any place. Be assured that we have always followed provincial regulations and recommended universal personal protection and disinfection protocols to limit transmission of all diseases in our office and continue to do so.

Despite our careful attention to sterilization, disinfection, and use of personal barriers, there is still a chance that you could be exposed to an illness in our clinic, just as you might be at your gym, grocery store or favourite restaurant.

“Social Distancing” has reduced the transmission of the Coronavirus. Although we have taken measures to provide distancing within our practice, due to the nature of the procedures we provide, it is not possible to maintain social distancing between the patient, orthodontist, orthodontic staff and sometimes other patients at all times.


​Please complete the form below and press submit.