Covid Pre-screening Form

Dear Patient,

We’re looking forward to seeing you at your upcoming dental appointment.

Our office complies with the State Health Department and CDC guidelines to prevent the COVID-19 virus.
Our staff are symptom-free and, to the best of their knowledge, have not been exposed to the virus. However, since we are a place of public accommodation, other persons (including other patients) could be infected, with or without their knowledge.
In order to reduce the risk of spreading COVID 19, we have asked you a number of “screening” questions below. For the safety of our staff, other patients, and yourself, please be truthful and candid in your answers.

We check for your current dental situation and decide your treatment. Our specialists will take care of your smile with dedication.