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PATIENT SCREENING FORM PATIENT NAME: PLEASE ANSWER ALL THE FOLLOWING QUESTIONS TO THE BEST OF YOUR ABILITYPREAPPOINTMENT DATE:OFFICE APPOINTMENT DATE:HAVE YOU BEEN DIAGNOSED W/ COVID-19?YES NOYES
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How to fill out dental covid screening form

01
Obtain a dental covid screening form from your dental office.
02
Read the instructions and questions on the form carefully.
03
Fill in the personal information section, including your name, contact information, and date of birth.
04
Review the list of symptoms related to covid-19 and mark any symptoms that apply to you.
05
Answer any additional questions about recent travel or exposure to individuals with covid-19.
06
Sign and date the form to confirm that the information provided is accurate and complete.
07
Return the filled-out form to your dental office prior to your appointment.

Who needs dental covid screening form?

01
Anyone who has an upcoming dental appointment may be required to fill out a dental covid screening form. This includes both new and existing patients.
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The dental COVID screening form is a document used by dental professionals to assess the risk of COVID-19 exposure and symptoms in patients before they receive dental care.
Dental patients are required to complete the dental COVID screening form prior to their appointment.
The dental COVID screening form is filled out by providing personal details, answering questions related to recent travel, symptoms, and exposure to COVID-19, and then submitting it to the dental office.
The purpose of the dental COVID screening form is to ensure the safety of both patients and dental staff by identifying potential COVID-19 risks prior to treatment.
The form must report personal health information, recent travel history, symptoms related to COVID-19, and possible exposure to confirmed cases of COVID-19.
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