COVID-19 PATIENT SCREENING FORM
At Sharon Nemec, DDS & Jeffrey Tom, DDS, your health and the health of our staff are of the utmost importance. To ensure your health and the health of our staff, we do follow usual universal precautions in our operatories and office. Additionally, every half hour to an hour we wipe down the waiting room and common spaces with disinfectant.
For the protection of all our patients and staff due the recent outbreak of coronavirus, we are requesting the following:
- If you have an illness or are exhibiting symptoms, we recommend you cancel and reschedule your dental appointment. Some illness and symptoms include:
- a cold or the flu
- fever or nausea
- severe headaches or body aches
- muscle or stomach pain, chest pain or difficulty breathing
- vomiting or diarrhea
- active tuberculosis (TB)
- mumps, measles, chickenpox
- other contagious disease
- Please notify our staff before your appointment if you or someone you are in close contact with have recently traveled to one of the countries with large outbreaks of COVID-19 (ex. China, Italy, Iran, South Korea) or if you have been exposed to someone else who was diagnosed with COVID-19 or who was quarantined as a precaution.
If you are healthy, there’s no need to cancel your regularly scheduled dental appointment.
If you have any questions or concerns, please contact us immediately. The below links provide additional information regarding the coronavirus:
Our team will continue to monitor the situation and provide updated information when warranted. Thank you for your patronage.