You must complete this screening questionnaire before each appointment
You must complete this COVID-19 screening questionnaire before each visit to our office on the day before your visit. Please confirm today's date and the date of your appointment.
Have you experienced any of the following symptoms in the past 14 days?
Please complete this questionnaire again if any of your answers change before your appointment.
Remember to wear a mask when entering the office. At this time, the public office washroom is currently closed.
Your information will be encrypted.
Family Dentistry in St. Catharines
Your browser does not support capabilities required for electronic signatures.
Click a signature you want to use:
Copyright © 1999-2021 Hush Communications Canada Inc.