• BALA INSTITUTE OF ORAL SURGERY

    COVID-19 PATIENT QUESTIONNAIRE
  • 15 N. PRESIDENTIAL BLVD, SUITE 301 s  BALA CYNWYD, PA 19004
    (610) 667-6161 s WWW.BALASURGERY.COM

    In the continually evolving COVID-19 crisis, we are complying with all protocols to ensure the health and safety of our patients and staff, following the CDC, ADA and PA Department of Health recommendations. All patients are required to follow specific guidelines. Please complete the following form NO EARLIER THAN 48 HOURS PRIOR to your scheduled appointment.  Thank you for your cooperation and understanding.

  •  / /
    Pick a Date
  •  / /
    Pick a Date
  • Browse Files
    Cancelof
  • Regardless of vaccination status, everyone is required to complete the following questions.

    WITHIN THE PAST 14 DAYS:

  • PATIENT GUIDELINES

    • If you are having sedation, after checking in, your driver must stay in their car and reachable via their cell phone for our staff.
    • If you do not need a driver, you are not having sedation or you are not a minor, please do not bring additional people with you.
    • Only patients will be allowed to enter the office (unless the patient is a minor – then one parent/guardian will be permitted in). Our waiting room is closed.No children will be allowed in the office. Please make necessary arrangements for child care.
    • All patients will have their temperature taken upon entering our office via touch-free infrared thermometers.
    • If you enter our office with any type of cough, you will be asked to leave and call us to reschedule your appointment.

    By signing below, I understand the above guidelines and have answered the questions honestly and to the best of my knowledge.

  • Clear
  •  
  • Should be Empty: