COVID-19 Patient Screening

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

Patient Name *

1. Have you tested positive for COVID-19 in the past 14 days? *

Yes

2. Have you been in contact with anyone with confirmed COVID-19 in the past 14 days AND been advised to self-isolate? *

Yes

3. Do you have, or have you had within the past 14 days, any of the following symptoms:

Fever above (38 degrees celsius) or feeling hot, chills/feverish *

Yes

Shortness of breath or other difficulties breathing *

Yes

Cough or worsening of a chronic cough *

Yes

Flu-like symptoms such as stomach upset, diarrhea, headache, fatigue or sore throat *

Yes

Recent alteration or loss of taste or smell *

Yes

Any new, unusual symptoms, e.g., feeling unwell, or sudden onset of runny nose *

Yes

4. Have you been in contact with anyone with any of the above symptoms of possible COVID-19 in the past 14 days AND been advised to self-isolate? *

Yes

5. If you have conditions or comorbidities that may make you more vulnerable to COVID-19 that you would like to share, please do so here:

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

Yes

"YES" responses to any of these questions would indicate the need for a deeper discussion with the dentist before proceeding with treatment.

7. Are you fully vaccinated against COVID-19? Fully vaccinated means that it has been at least 14 days since you received the second dose of the Pfizer, Moderna, or AstraZeneca COVID-19 vaccine or the Janssen COVID-19 vaccine.

Yes

Prefer not to answer

Spam Blocker

At Family Dental Care in Prince George and Vancouver, our passion is oral health. Our dentists, specialists and dental team are committed to helping you maintain your smile and your overall health.
- The Family Dental Care Team

COVID-19 Patient Screening

New Patients Always Welcome