COVID-19 PATIENT SCREENING QUESTIONNAIRE

                                                                                                                                            

  • Do you have a fever, or have you felt feverish recently? 

  • Do you have a cough? 

  • Are you having shortness of breath or any difficulty breathing? 

  • Do you have chills or repeated shaking with chills? 

  • Do you have any muscle pain? 

  • Do you have any recent onset of headache or sore throat? 

  • Do you have any other flu-like symptoms?

  • Do you have any recent loss of taste or smell? 

  • Have you experienced any recent GI upset or diarrhea?

  • Are you in contact with anyone who has been confirmed to be COVID-19 positive? 

  • Have you traveled in the past 14 days to any regions affected by COVID-19? 

  • Have you had or diagnosed with COVID-19 positive within the last six months?

  • Have you had any of the above described COVID-19 symptoms within the last six months, but not have been tested?

If you answered "yes" to any Covid-19 questions, please call our office as soon as possible to discuss your responses. Thank you for helping us keep you and your family safe.

 

Kingston Family Cosmetic Dental Team

Services

Family Dentistry

Dental Implants

Cosmetic Dentistry

Invisalign

Dental Veneers

Dentures

Root Canals

Crowns and Bridges

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Dental Surgeries

Teeth Whitening

Restorative Dentistry

Botox and Dermal Fillers

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TMJ Treatment

Orofacial Pain Treatment

Bruxism Treatment

Perio Laser Therapy

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Kingston Family Cosmetic Dental Center

310 Kresson Road, Cherry Hill, NJ 08034

PO Box 1980, Cherry Hill, NJ 08034

Tel: 856-795-9007

themegasmile@gmail.com

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Office Hours

Monday: 10am - 8pm

Tuesday: 8am - 6pm

Wednesday: 10am - 8pm

Thursday: 10am - 4pm

Friday : 9am - 1pm

Saturday : 9am - 1pm