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

630-369-0101

Print Print | Sitemap
© Naperville Dental Associates

This website was created using 1&1 IONOS MyWebsite.