• COVID-19 Screening Form

  • In an effort to minimize the risk of spread of COVID-19 and in accordance with the guidelines as set out by the Ontario Ministry of Health, the Royal College of Dentists of Ontario (RCDSO), and the College of Dental Hygienists of Ontario (CDHO):

    All persons entering DOWNTOWN DENTAL for an appointment or for any other reason must complete the following questions prior to your visit.

    Thank you for your understanding and for helping STOP THE SPREAD.

  • Patient Acknowledgement:

    COVID-19 Pandemic Emergency Dental Risk
  • Please read the patient acknowledgment below and initial or sign as indicated.
  • if applicable, approximate date of the test.

  • Clear
  •  - -
    Pick a Date
  • Adapted from Dental Association of PEI COVID-19 Pandemic emergency/Dental Risk acknowledge by Patient

  • Should be Empty: