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New Patient - Covid-19 Notice

Together we can reduce the risk posed Together we can reduce the risk posed

Casa Dental follows all American Dental Association (ADA) recommendations to help limit the risk of spreading Covid-19. Infection control has always been a top priority for our practice, and we’ve likewise increased our protective measures to help keep you and our staff safe.

We ask that all patients read the information below and tell us if you answered YES to any of the questions prior to coming to the office. We will provide you with an ADA screening form prior to your appointment or at the beginning of your appointment.

Thank you for being our patient and working with us to keep all of us safe. We value your trust and loyalty and look forward to seeing you at Casa Dental.

Pre-Appointment Office
Date:
Date:
Do you/they have fever or have you/they felt hot or feverish recently (14-21 days)?
Yes No
Yes No
Are you/they having shortness of breath or other difficulties breathing?
Yes No
Yes No
Do you/they have a cough?
Yes No
Yes No
Any other flu-like symptoms, such as gastrointestinal upset, headache or fatigue?
Yes No
Yes No
Have you/they experienced recent loss of taste or smell?
Yes No
Yes No
Are you/they in contact with any confirmed COVID-19 positive patients?

Patients who are well but who have a sick family member at home with COVID-19 should consider postponing elective treatment.
Yes No
Yes No
Is your/their age over 60?
Yes No
Yes No
Do you/they have heart disease, lung disease, kidney disease, diabetes or any auto-immune disorders?
Yes No
Yes No
Have you/they traveled in the past 14 days to any regions affected by COVID-19? (as relevant to your location)
Yes No
Yes No

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

  • For testing, see the list of State and Territorial Health Department Websites for your specific area’s Information
ADA Approved Chart

If you have an questions, please give us a call. We’re happy to help!