COVID-19 Patient Screening

Please answer the following questions to ensure you are COVID-19 symptom free.

Patient Name *

Date *

It is important to closely monitor your health and the health of those you care for to help prevent the spread of COVID-19 and other illnesses like the flu.

1. Do You Feel Sick? *

Yes

2. In the past 48 hours, have you had, or are you currently experiencing;

Cough (New or Worsening) *

Yes

OR two or more of the following symptoms (new or worsening);

Fever (i.e. chills/sweats) *

Yes

Sore Throat *

Yes

Runny nose/nasal congestion *

Yes

Headache *

Yes

If yes, go home or stay home as noted above. Follow Public Health instructions for testing and isolation.

3. Have you recently visited a COVID-19 exposure site? *

Yes

4. Have you travelled in the past 14 days outside of the province and/or country AND been advised to self-isolate? *

Yes

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Welcoming New Patients

We are happy to accept new patients to our dental clinic. Don't hesitate to contact us and take the first step in receiving dental treatment from our team.

We are a proud member of
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