• COVID-19 Health Screening Questionnaire

  • Dear Patient:

    You are scheduled to come to our office for dental services that will be done during the COVID-19 pandemic. Please be advised of the following:

    While our office complies with State Health Department and CDC to prevent the spread of the COVID-19 virus, we cannot make any guarantees.

    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 will ask 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.

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