Peel Orthodontics :: COVID 19 Health declaration and informed consent

COVID -19 Health declaration and informed consent for our patients

Thank you for your 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. Please rest assured that Peel Orthodontics is closely monitoring developments of the COVID-19 pandemic through Department of Health, Government authorities and Australian Dental Association.

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

Please bring your phone to your appointment. We encourage all our patients to have the COVID-19 App active to ensure contact tracing.

Please answer the following questions to assist us in protection of all our patients, staff and the community at large.

Are you, or is anyone in your household feeling unwell, including but not limited to experiencing possible COVID-19 symptoms? *
Have you or anyone in your household, within the last 14 days travelled overseas, out of WA or in contact with anyone from any other state? *
Have you or anyone in your household, within the last 14 days, have had contact with a confirmed or suspected case of COVID-19? *
Have you or anyone in your household been exposed to a potential risk during your or their line of work OR working/residing in one of the current hot spots? *

If you have had contact with a person with confirmed COVID-19 whilst infectious, self-isolate for 14 days.

If you have answered YES to any or one of the above - please contact the office at 08 9586 9653 to discuss.

By submitting this form, you are agreeing to our privacy policy.

Stay tuned

Peel Orthodontics Suite 3/5 Murdoch Dr
WA, 6210