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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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