Patient Screening Form

    Please fill out this mandatory screening form based on the new guidelines established by the NB Dental Society.

    1. Do you have a fever or have felt hot or feverish anytime in the last two weeks?
    2. Do you have any of these symptoms: Dry cough? Shortness of breath? Difficulty breathing? Sore throat? Runny nose?
    3. Have you experienced a recent loss of smell or taste?
    4. Have you been in contact with any confirmed COVID-19 positive patients, or persons self-isolating because of a determined risk for COVID-19?
    5. Have you returned from travel outside of the Atlantic bubble or Zone 1,2 or 3 or Halifax area in the past 14 days?
    6. Are you over the age of 65?
    7. Do you have any of the following? Heart disease, lung disease, kidney disease, diabetes or any auto-immune disorder?