PATIENT SCREENING QUESTIONNAIRE COVID-19

Please be aware:

The following patients are discouraged from receiving any dental care other than essential care (for an issue that could become an emergency if treatment is delayed) or emergency care due to their high-risk status as defined by the Centers for Disease Control:

• Patients age 65 or older
• Patients who are pregnant
• Stroke survivors

Patients who are immunocompromised or who have other chronic health conditions including but not limited to the following:

• Lung disease (including asthma)
• Lupus
• Diabetes
• HIV
• Chronic heart disease