Naperville Dental Associates
NapervilleDental Associates

Covid-19 Screening

Do you have a fever or have you felt hot or feverish

recently(14-21 days)?                                                                       Yes   No


Are you having shortness of breath or

difficulty breathing?                                                                           Yes  No


Do you have a cough?                                                                      Yes  No


Any other flu like symptoms, such as gastrointestinal upset

headache, or fatigue?                                                                        Yes  No


Have you experienced recent loss of taste

or smell?                                                                                             Yes  No


Are you in contact with any confirmed COVID-19 positive

patients?                                                                                              Yes  No


Do you have heart disease, kidney disease, diabetes

or any auto-immune disorders?                                                           Yes  No


Have you traveled in the past 14 days to any regions affected

by Covid-19?                                                                                       Yes  No



Joe Petrauskas DDS

Karen Rudman DDS

1220 Hobson Road

Suite 240

Naperville, IL 60540


Print | Sitemap
© Naperville Dental Associates

This website was created using IONOS MyWebsite.