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COVID-19 Screening Questionnaire  
COVID-19 Screening Questionnaire  
Form length: 2-4 mins
COVID-19 Screening Questionnaire
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    COVID-19 Patient Screening

    Please fill in the following information. Your answers are for our records only and will be kept strictly confidential subject to applicable laws. You will be asked some questions concerning COVID-19 and your overall health. We only ask for information that is absolutely needed for us to protect our patients, staff, and community.

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