Dear valued patient,
To prepare for your upcoming appointment we require some additional information from you. 30 minutes prior to every appointment you will receive a link via text message to our secure and confidential pre-screening health form. This form will include questions about your recent medical and travel history, and briefly discuss the Covid-19 pathogenesis in the world of dentistry. When you have completed the form, you may submit it to us electronically using the integrated SUBMIT button. If you answer ‘yes’ to any of the pre-screening questions, please contact the office to reschedule your appointment for a later date. If you do not have a cell phone, you will be invited to fill out a paper copy at the start of your appointment. No financial penalties will be accrued due appointments cancelled because of illness. Out of respect to other patients and/or staff who may be classified as high risk please do not enter our office if you are feeling ill. Until further notice you will be required to fill out this Covid Consent form within 24 hours of every appointment in our office.
You will notice a few changes around the Urban Smiles office:
1) 30 minutes before your appointment you will receive an automatically sent text message
from our computer asking that you announce your arrival with a single word: ARRIVED.
This will prompt our computer to check you in for your appointment, and your clinician
will invite you in when they are ready to receive you.
2) Upon arrival we ask you do not enter the office without an invitation from a staff
member. Please remain outside until invited in. This allows us to control the number of
people walking through our hallways at any given time.
3) Upon entering the office, you will be asked to use hand sanitizer and immediately
directed to your clinical room. Please wear a face mask to your appointment if you have
one. If you do not, you will be provided with one. Please leave all cell phones and other
personal belongings safely tucked away in your purse or pocket. This prevents the
opportunity for cross-contamination. No outside food or drinks will be allowed in the
office. Please refrain from touching your hair/face/inside of your mouth while in the
4) Regarding billing please ensure any changes to billing information or insurance
information is done ahead of time. This will allow for a seamless departure from the office
with minimal time spent at reception. Ideally, we would like a credit card on file so that
we can process payment manually without any touch contact. Reception will avoid
sending you home with any paperwork and will instead offer to email you your receipts
and appointment information.
5) Clinical staff will be wearing head-to-toe PPE during any aerosol generating procedures.
This may include custom-fitted respirator masks and face shields, and fabric gowns and
hairnets which will be changed after each patient. Clinical staff will no longer be offering
complementary appliance cleanings, so please leave your nightguards and retainers at
home unless directly related to your appointment.
6) Only one person will be permitted to enter the clinical operatory with our team members.
Unfortunately, this means no parents/guardians with children, and all friends and family
attempting to enter the office with scheduled patients will be asked to remain outside.
Exceptions may be made for legal obligations.
7) At the end of your appointment clinical staff will pre-book your next visit and send you
to reception to finish up. Please check with the reception desk before leaving the office.
Reception will confirm your next appointment, ensure all billing information is in order,
and then release you.
If you have any of the following pre-existing medical conditions, please be advised that you are
classified as ‘high risk’. This means that, should you fall ill with Covid-19 your symptoms may
be more severe than that of the population not within the high-risk group:
Serious respiratory disease
Serious heart conditions
Chronic kidney disease, or those undergoing dialysis, and liver disease
Patients who are pregnant
Patients who are 70 years of age and older
We will be doing extensive sanitization between patients, and Surgically Clean air purifiers will be running in every operatory for the duration of every day. Now more than ever it is vital that all patients are prompt for their arrival times to ensure we have ample time for proper sanitization and to not impact the patients following you.
Also, please be advised that for the foreseeable future we will be charging a Covid-19 PPE fee to help us cover the sudden and unexpected overhead of the new protective equipment. This fee was proposed to us by the College of Dental Surgeons at a base price of $10.00 per appointment. If you have any questions or concerns regarding this information or our Covid-19 consent form, please contact our office at 250-381-9876 or email us at firstname.lastname@example.org.