This screening form should be used twice; once during pre-screening (e.g. over the phone when confirming theappointment), and a second time when the patient presents at the office for their appointment. Answers tothese questions must be documented in the patient record.
2. Do you have or recently had (14-21 days) any of the following symptoms:
“YES” responses to any of these questions would indicate the need for a deeper discussion with the dentistbefore proceeding with treatment. Whenever possible, patients with one or more risk factors should berescheduled to a later date.
Royal Centre Dental Group
1055 W Georgia St #210,
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