COVID-19 Questionnaire

In order to increase the safety of all patients and staff, all patients are expected to fill out a COVID-19 Questionnaire Screening Form before being treated. One questionnaire needs to be completed per patient. Completing the form prior to being seen at the office will increase the speed at which the patient can be seen, and reduce the time a family needs to be in the office.

Scroll down for access to the questionnaire. It can be completed in as little as 5 minutes, but will greatly save processing time once in the office, making your appointment faster and more efficient. Please print out the form, and bring it with you to the office. Simply check off the boxes in the “Pre-appointment” column for information regarding the last few weeks, and “In-office” column can be completed the day of the appointment. Patient temperature on the day of the appointment will be recorded by staff.