1920 Ellesmere Rd #201, Scarborough, ON M1H 2V6, Canada
Call Today! (416) 438 0778

Patient Screening Form

Staff experiencing symptoms of COVID-19 must immediately go home and not return to work until after consulting with their physician and/or after they are symptom-free following 14 days of self-isolation.

Patient Screening Form

Use this form to screen patients before their appointment and when they arrive for their appointment.

Who answered: PatientOther

Identify yourself and explain the purpose of the call, which is to determine whether there are any special considerations for their dental appointment. Have the patient answer the following questions.


Have you had close contact with anyone with acute respiratory Illness or
travelled outside of Ontario in the past 14 days?

Do you have a confirmed case of COVID-19 or had close contact with a
confirmed case of COVID-19?

Do you have any of the following symptoms:
•New onset of cough
•Worsening chronic cough
•Shortness of breath
•Difficulty breathing
•Sore throat
•Difficulty swallowing
•Decrease or loss of sense of taste or smell
•Unexplained fatigue/malaise/muscle aches (myalgias)
•Nausea/vomiting, diarrhea, abdominal pain
•Pink eye (conjunctivitis)
•Runny nose/nasal congestion without other known cause

Are you 70 years of age or older, experiencing any of the following
symptoms: delirium, unexplained or increased number of falls, acute
functional decline, or worsening of chronic conditions?


Professionals can help in writing your assignment should you need help. The essays are a reflection of the students’ ability to perform academically and their potential. They show what they have learned throughout the course write my thesis statement of their studies, how they analyze and analyze materials, as well as how they adhere to the instructions. These are some helpful tips for you to use in your essay.

Call Now Button