Dear Patient:

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

Please be advised of the following:

 

  • 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.
  •  

    Covid Pre-Screening Form











    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo