COVID-19 Forms

Keeping You and Your Smile Safe

We've missed you! We're excited to open up and start seeing your smiles again.

Your safety, as well as the safety of our team, is our top priority. Rest assured that we're following all of the CDC and American Dental Association recommendations. We appreciate your patience as we reschedule over 1000 canceled appointments. We'll be rescheduling on a first-canceled-first-rescheduled basis.

Please read the letter below and read through and sign the Health History and Questionnaire and Consent for below. We apologize for additional paperwork, but we're doing everything we can to keep everyone healthy and safe!

A Letter to Our Patients

We are beyond ready to get back to work and see every one of you that we have missed so much!  We hope this letter finds you healthy, happy and prepared to ease back into some regular routines. While many things have changed since we last saw you, one thing remains the same: our commitment to your and our team’s safety. 

We are so excited to be opening up soon and cannot wait to see your smiling faces!  As we begin the first phases of opening HGO, we will be following rigorous scheduling protocols and office measures to ensure the safety of both our patients and our team members at HGO. 

First and foremost, all appointments between March 17th to May 31st, 2020 have been canceled and will be rescheduled. You do not need to call the office to reschedule your appointment, our team will be calling over the next several days to reschedule all missed appointments. We will be rescheduling patients on a first-canceled-first-rescheduled basis, which is fair, efficient, and will serve everyone with getting back on track.  

We ask for your patience and understanding during this time as we had to cancel over 1000 appointments and we know there is a strong desire to get your treatment back on track as soon as possible. The great news is that we will be opening both offices almost every day so that we can maximize the number of patients that we see while also maintaining social distancing!

As previously mentioned, we have made several changes to our scheduling and office protocols that are designed to keep everyone safe while we follow all CDC requirements and ADA recommendations. We will, as always, provide a positive and comfortable experience for our patients even though you’ll notice the following changes:

  • You will receive a phone call to reschedule your canceled appointment. Again, you do not need to call the office to reschedule as we have kept track of the time and date of all canceled appointments and will be rescheduling them in the order in which they were canceled.
  • Brush your teeth BEFORE your appointment as the brushing stations will be closed for now.
  • On the day of your appointment, please go to and fill out the COVID-19 Screening Form at the bottom of the page. The simple questionnaire will assess your contracts, travel, and well-being. Any question indicating recent exposure to someone with COVID-19 or having signs and symptoms of the same will also need to reschedule their appointment.
  • When you arrive, please stay in your car and call the office at 434-296-0188 (Charlottesville) or 434-205-4457 (Crozet) as our front doors will remain locked. Our front desk will make sure that we have all of your forms completed. When your chair is available, one of our wonderful team members will call you and invite you into our office where they will take your temperature with a touchless thermometer. If your temperature is over 100 degrees F, we will need to reschedule your appointment.
  • We ask that only the patient that is being treated enter the office.  Exceptions can be made for our younger patients. Of those, only one parent/caregiver may accompany the patient and we will also need to take your temperature and ask that you wear a mask. If you do not have one, we will provide one; however, personal protective equipment supplies are low nationwide and we ask that you help conserve them by bringing one from home.
  • The patient restroom will also be closed, so please prepare for this before arrival. Also, our water and coffee station, as well as the toy sections, have been removed for the time being.  
  • You will find that our furniture has also been rearranged in a manner to help maintain social distancing
  • Patients will rinse with a 3% hydrogen peroxide mouth rinse for 30 seconds and then spit it back in the cup.  This will be suctioned up for disposal.
  • Patients will be seated at least 6 feet apart and no one will be in adjacent chairs to help maintain social distancing
  • All patients will be given a "progress report card" with details about what we completed at that appointment and what our plans are for their next appointment. We want to make sure to keep parents in the loop of how we are progressing!
  • All team members will be wearing personal protective equipment (PPE) according to recommendations from the CDC, ADA, and OSHA.  
  • We will also take the temperature of every team member, including both doctors, immediately upon arrival at work and after lunch.  Any team member with a temperature over 99.7 degrees F will be sent home
  • Our team members will also answer the same COVID-19 health questionnaire as our patients are required to answer and will do so every day.  If any of the questions disqualify the team member, they will be sent home

Please know that even with all of these changes, the same warm, loving people will be behind all of our PPE. We LOVE our patients at HGO and are so grateful for every one of you. This time away has only served to make us more thankful for each of you and this is why we are taking your safety very seriously. If you have any questions or concerns, please feel free to text our office at 434-296-0188 and one of the doctors or team members will get back to you as soon as we can. We thank you again for your continued understanding and patience as we ease back into our new normal while still providing healthy and amazing smiles in the safest manner possible!


Drs. Hamer and Glassick