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COVID-19 Form

 Patient Forms 

At the recommendation of the ADA, we are requiring patients complete a COVID-19 patient screening form before your visit to our dental office.  By completing this form prior to your appointment at our office, each patient plays an important role in reducing contamination in the office, minimizing the time spent in the waiting room, and streamlining our patient flow process to keep dental visits safe, efficient, and enjoyable.  Please print out the attached form, complete it, and bring it to the office on your next visit.  You are welcome to contact our office at (407) 324-4420 with any questions.  

ADA_Patient_Screening_Form.pdf