Online Patient Screening Form

Dear Patient,
To ensure the best experience as well as to put you at ease for your upcoming dental visit, our team has put together these guidelines you will need to follow. They will help you better prepare for your dental visit with our caring team who will be utilizing the latest safety protocols taken from the CDC, ADA® and NY State Dental Association. During these unfortunate circumstances, we want to ensure the safety of our patients and our team members.

  • Please make sure you properly fill out our pre-screening form and email it back to us: prior to your visit.
  • Please provide all necessary dental/medical insurance information prior to your visit.
  • Please make sure to wear your mask to your dental visit.
  • Please bring your own pen.
  • You are required to communicate with our team if something in your medical condition has changed or you might have been exposed to COVID-19 since we received your pre-screening information.
  • Dental appointments are in great demand, so please communicate with the team about any possible changes to your scheduled time at least 48 hours in advance to avoid appointment cancellation fees.
  • Proper PPE and disinfection protocols are used specifically for your dental needs in your allocated time, so please be mindful of all extra efforts and teamwork we put together to ensure proper dental care experience.
  • You will need to call from outside when you arrive for your appointment and wait for further instructions.
  • You will need to come alone for your dental visit unless you require special assistance.
  • Upon your arrival for your dental visit, please be advised that you will be greeted by a smiling team member who will ask you pre-screening questions and obtain your temperature with an infrared touchless thermometer. If your temperature is over 100.4 degrees, you will be asked to leave and call to reschedule your appointment.
  • Once your arrival process is complete and you are cleared for your visit, our front desk will check you in and you will be able to wait in our waiting room until you are called in for your visit.
  • Prior to your exam with your dental provider, a mouth rinse with special medication will be given to you to use, and to ensure proper infection protocols, you will also be given hand sanitizer.

We appreciate everyone’s cooperation during these difficult times. Furthermore, we understand how stressful these past months have been for everyone, and we want to assure you that we are practicing the safest protocols and updating them as new information comes in about this new virus. Your visit will have a new norm for your benefit and health. Feel free to reach out to us via email: so we can clarify any questions you may have prior to your appointment.

We look forward to seeing you so we can provide the best help for your oral health.