COVID-19 Pandemic Patient Questionnaire
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If the answer is YES to any of the following questions, please reschedule your appointment.
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Positive responses to any of the below questions would likely indicate a deeper discussion with your primary care provider before proceeding with elective dental treatment.
Have you had a fever above 100°F in the last 14-21 days?
Have you experienced recent loss of taste or smell?
Do you have shortness of breath or difficulty breathing?
Have you had contact with any COVID-19 positive patients?
Do you have or have had a cough in the last 14 days?
Do you have any other flu-like symptoms, such as gastrointestinal upset, headache, or fatigue?
Have you traveled in the past 14 days to any regions affected by COVID-19?
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© 2020 Happy Teeth Dental Care, PC

Happy Teeth Dental Care

135 Boston Turnpike 

Shrewsbury, MA 01545

Office Phone Number: (508) 425-3316

Office Fax Number: (508) 753-3318