You have come to our office today for a routine dental evaluation and/or treatment that wil be done during the COVID-19 pandemic. Please be advised of the following:
While our office complies with State Health Department and the Centers for Disease Control and Prevention infection control guidelines to prevent the spread of the COVID-19 virus, we cannot make
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.
HAVE YOU BEEN DIAGNOSED POSITIVE FOR THE COVID-19 VIRUS AT ANY TIME?
ARE YOU CURRENTLY AWAITING THE RESULTS OF A COVID-19 TEST?