Patient Screening Form.

 https://success.ada.org/~/media/CPS/Files/Open%20Files/ADA_Patient_Screening_Form.docx

Please download, complete and return either via email [email protected] or fax 319-866-9662 48 hours prior to your appointment.

 

BEFORE YOUR APPOINTMENT PLEASE READ BELOW FOR SOME CHANGES

  • We will prescreen a couple days before your appointment and the day of your appointment for COVID-19
    • Any symptoms of cough, fever, upper respiratory problems or recent diagnosis will require appointments to be rescheduled to a future date
  • Please call before entering the office for the screening and additional instructions
  • Temperatures will be taken and recorded.  Any temperature over 100.4 the appointment will be rescheduled
  • Patients will need to wear their own mask upon entering the office
  • Hand sanitizer will be available and may be asked to use throughout your appointment
  • Only the patient will be allowed in the office unless accompanying a minor
  • A prerinse of chlorohexidine (prescription rinse used commonly after oral surgeries) will be given prior to sitting in the chair
  • Our office will be colder due to all our extra protective equipment so please plan accordingly
  • We will do our best to find appointment times that work for you, but understand we may not have it available for some time due to limiting number of patients in the office and limiting procedures right now
  • THANK YOU FOR YOUR UNDERSTANDING - WE ARE EXCITED TO BE ABLE TO HELP OUR PATIENTS AGAIN!