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?

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• 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?

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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

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