PRE-APPOINTMENT SCREENING

Download & Print Patient Screening Form

Please answer the following question for each person coming to the appointment. Positive response to any of these would likely indicate a deeper discussion with the dentist 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 difficulties breathing?
Do you have a cough?
Any other flu-like symptoms, such as gastrointestinal upset, headache or fatigue?
Have you experienced recent loss of taste or smell?
Have you been in contact with any confirmed COVID-19 positive patients?

Patients who are well but have a sick family member at home with COVID-19 should consider postponing elective treatment.

Have you traveled outside the state of South Dakota in the past 14 days?

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