COVID-19 Screening

Ready to come in?

Please complete COVID-19 screening form below. If you have any questions call us on (615) 348-1008.

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Name:(* required)

Do you have a fever today or within the last 10 days?(* required)

Yes
No

Are you having shortness of breath or other difficulties breathing?(* required)

Yes
No

Do you have a cough?(* required)

Yes
No

Do you have any other flu-like symptoms, such as gastrointestinal upset, headache/body ache or fatigue?(* required)

Yes
No

Have you experienced recent loss of taste or smell?(* required)

Yes
No

Have you been in direct contact with any confirmed COVID-19 positive people in the last 10 days?(* required)

Yes
No

People who are well but who have a sick family member at home with COVID-19 should consider postponing elective treatment.

Positive responses to any of these COVID-19 questions would likely indicate a deeper discussion with the dentist before proceeding with elective dental treatment.

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