COVID-19 Pre-Screening Form

COVID-19 Patient Pre-Screening

Our patient’s safety & health is important to us at Dobbs Ferry Family Dental. To prepare for your visit during this pandemic, we ask you to answer the questions on the pre-screening form below. The column to the left is completed at the time you make your appointment.

Upon arrival at our office, we kindly ask you to telephone our front desk from your car for instructions as to when you can enter the office. When you enter the office, you will be asked to complete the column on the right side of the form.

Also, please note that if you require assistance, you can be accompanied by only one person. You, and anyone accompanying you, must wear a mask upon your arrival, then proceed to the reception window and use the hand sanitizer that is provided. 

Please find attached form below,

COVID-19 Pre-Screening