IMPORTANT: These two forms must be completed online prior to your appointment! 

Supplemental Informed Consent
Supplemental Health Questionnaire


We hope this finds you and your family in good health. Our community has been through a lot over the last few months, and all of us are looking forward to resuming our normal habits and routines. While many things have changed, one thing has remained the same: our commitment to your safety.

Infection control has always been a top priority for our practice and you may have seen this during your visits to our office. Our infection control processes are made so that when you receive care, it’s both safe and comfortable. We want to tell you about the infection control procedures we follow in our practice to keep patients and staff safe.

Our office follows infection control recommendations made by the American Dental Association (ADA), the U.S. Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA). We follow the activities of these agencies so that we are up-to-date on any new rulings or guidance that may be issued. We do this to make sure that our infection control procedures are current and adhere to each agencies’ recommendations.

You may see some changes when it is time for your next appointment. Although some of these may seem strange, it is all being done out of an abundance of caution for your health, as well as that of the other patients being seen in the office, the doctor and the staff, and any public with whom they might come in contact. We made these changes to help protect our patients and staff.


  • We have cancelled over 9 weeks of appointments, and will do our best to see everyone in a timely and efficient manner.  Being closed for over 9 weeks, in addition to all the new protocols we must follow, greatly increases the time we need for each and every appointment.  It will take several months for us to get “caught up” and back to “the new normal.”
  • We will allow 30 minutes for every appointment…for 95% of our patients, this is enough time to ensure we can handle all issues, and get you “back on track.”  If you fall into the 5% group of patients that need more than 30 minutes, we will reschedule to allow more time.
  • All laser procedures will be delayed until further notice.
  • Appointments will be managed to allow for social distancing between patients. That might mean that you’re offered fewer options for scheduling your appointment.
  • We will do our best to allow greater time between patients to reduce waiting times for you, as well as reduce the number of patients in the reception area at any one time.
  • Due to the backlog of appointments, additional time needed per appointment, and extra preparation needed for the new precautions, Please arrive “on-time” for your appointment…being 10 minutes late will most likely result in rescheduling your appointment.
  • You may see that our waiting room will no longer offer magazines, children’s toys and so forth, since those items are difficult to clean and disinfect.


  • Patients should brush their teeth before coming to our office; they will not be able to brush them in the office.
  • Our restrooms will be closed.
  • When you arrive in the parking lot, please text the patient’s full name to (412) 426-3569…we will text back when it is time to send them into the office.
  • Please only send the patient into the office for their appointment. If absolutely necessary, 1 adult may accompany them into the waiting room, but not the clinic…only patients and staff will be permitted in the clinic.
  • Everyone entering the office must wear a mask (we will not provide masks, as our supplies are limited).
  • Everyone entering the office will have their temperature taken via a touchless forehead scan. If over 100.4 degrees, we will reschedule their appointment.
  • Everyone should be careful not to touch anything unless absolutely necessary…keeping your hands in your pockets is a good way to remember this.
  • If you would like to speak to the Dr. or staff, please phone us. All appointments will be made via phone, not at the front desk.