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COVID-19 Pre-Screen Questionnaire

You’ll notice a few differences when you visit, but the care you receive won’t be one of them. Here are a few things you’ll see:

  • We will use no-touch mobile communications such as text, email and phone.
  • We will ask you to wait in your car and text us upon arrival.
  • Hand sanitizer is readily available.
  • Temperature checks help us screen everyone.
  • We’re using some new protective gear.
  • If you’re not feeling well, we can help you reschedule.

There are also a few things behind the scenes that might not stand out. Just a few include:

  • Added cleaning and disinfection of public spaces.
  • Continued strict sterilization monitoring.
  • More training than required on protective measures

Did we mention that we’re excited to see you? But before we do, please take a minute to fill out the pre-appointment screening and health history forms! Thank you.

Do you or have you had a fever of above 100 degrees in the past three days? *

Yes No

Have you recently lost or had a reduction in your senses of smell or taste? *

Yes No

Do you have a sore throat? *

Yes No

Do you have a dry cough? *

Yes No

Do you have a runny nose? *

Yes No

Have you been in contact with someone who has tested positive for or suspected they were positive for Covid-19 (corona virus?) in the last two weeks? *

Yes No

Have you tested positive for Covid-19 or are you awaiting test results for Covid-19 within the last 10 days? *

Yes No
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You don't have to settle for feeling self-conscious about imperfections in your smile. If you are in the Marrero, LA area, Give Smile In Style, Diem Do DDS a call today at (504) 370-2229 to book a consultation.