COVID-19 Pandemic Patient Questionnaire
If the answer is YES to any of the following questions, please reschedule your appointment.
Positive responses to any of the below questions would likely indicate a deeper discussion with your primary care provider before proceeding with elective dental treatment.
Do you have a fever or have you felt hot or feverish recently (14 -21 days)?
Are you having shortness of breath or other difficulty breathing?
Do you have a cough?
Do you have any other flu-like symptoms, such as gastrointestinal upset, headache, or fatigue?
Have you experienced recent loss of taste or smell?
Are you in contact with any confirmed COVID-19 positive patients? *Patients who are well but who have a sick family member at home with COVID-19 should consider postponing elective treatment.
Have you traveled in the past 14 days to any regions affected by COVID-19?

Office Phone (781) 664-3172

Office Fax (781) 399-0845

340 Wood Rd #288, Braintree, MA 02184, USA

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