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Covid-19 Form

Dear Roeder Orthodontics Patients, Parents and/or Guardians,

Due to the COVID-19 pandemic, it has become necessary that we ask all parents/patients to complete the following questionnaire:

  • We do understand the concern regarding the current COVID-19 status.

    We here at Roeder Orthodontics are dedicated to providing a clean and sanitary environment to ensure the health and safety of all patients and staff, alike. It is our goal to provide all Roeder Orthodontics patients the ability to receive their orthodontic care, in light of the current outbreak.

    By signing below, you acknowledge that the treatment being provided during this time is completely voluntary and the patient does not have emergent needs.