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- - Dr. Gavin Forsyth
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Home
COVID-19
Our Team
Our Doctors
Dr. Gavin Forsyth
Dr. Benjamin Chih-I Chang
Office Tour
Procedures
Cleanings and Prevention
Fluoride Treatment
Sealants
Dental X-Rays
Home Care
Cosmetic Dentistry
Tooth Whitening
Composite Fillings
Porcelain Veneers
Porcelain Crowns (Caps)
Dental Implants
Porcelain Inlays
Porcelain Onlays
Porcelain Fixed Bridges
Periodontal Disease
Diagnosis
Treatment
Maintenance
Restorations
Composite Fillings
Crowns (Caps)
Dental Implants
Fixed Bridges
Amalgam Fillings
Invisalign
Gallery
Patient Info
Financial Policy
Appointment policy
New Patient Forms
Educational Video
Blog
FAQs
Forms
New Patient Forms
Covid Forms
Contact Us
Book Appointment
Links
COVID screening form
Patient Name:
Date of Birth:
Email Address
Screening Questions
1. Do you have any of these symptoms: Fever or chills? Cough? Loss of sense of smell or taste? Difficulty breathing?
Yes
No
2. Do you have: a sore throat? Loss of appetite? Extreme fatigue or tiredness? Headache? Body ache? Nausea, vomiting or diarrhea?
Yes
No
3. Have you returned from travel outside Canada in the last 14 days?
Yes
No
4. Have you had close contact with anyone diagnosed with lab- confirmed or suspected COVID-19?
Yes
No
5. Have you lived or worked in a setting that is part of a COVID-19 outbreak?
Yes
No
6. Have you been advised to self-isolate or quarantine at home by public health?
Yes
No
Any “yes” response for questions 1-5 must be discussed with the managing dentist immediately.
If “yes” to 2 or more of these symptoms: Stay home until you feel better. If symptoms don’t get better or get worse, contact a health care provider, or call 8-1-1about your symptoms and next step.
Patients are advised:
o To sanitize their hands; answer the questions again; have their temperature taken.
o Only patients are allowed to come to the office.
o If possible, to wait in their car until their appointment, call the office when they arrive.
o When patient arrives for their appointment, responses must be confirmed and recorded.
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Clear Dental COVID-19 Safety Protocol
Learn More
Clear Dental 傳染性肺炎防護措施
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