COVID-19 Questionnaire and Informed Consent Online Form

New Guidelines to Keep Our Patients Safe and Healthy

Prior to entering the office, all patients will need to complete and submit an informed consent to treatment, as well as a COVID-19 questionnaire to help screen for possible symptoms. These online forms are available below. Please have them filled out before visiting the office by either completing the web form or printing the PDF form and bringing it with you to your appointment.

patient information form for dentist COVID-19 Questionnaire and Informed Consent Form (PDF)

If you are uncomfortable coming into the office for any reason, we are happy to move an existing appointment out to a later date. If you have any questions about the new protocol or about scheduling please call the office at 336-288-4499.

We're excited to see your smiling faces again!