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805 W Broadway #1105
Vancouver, BC
Monday-Thursday
Office Hours
Home
About Us
Testimonials
FAQ
Financial Policies
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General Dentistry
Restorative Services
Root Canal Treatment
Emergency Dentistry
Botox®
Invisalign®
Gallery
*
New Patients Welcome
*
COVID-19
Our Safety Measures
Patient Screening Form
Appointment Instructions and What to Expect
Menu
Home
About Us
Testimonials
FAQ
Financial Policies
Services
General Dentistry
Restorative Services
Root Canal Treatment
Emergency Dentistry
Botox®
Invisalign®
Gallery
*
New Patients Welcome
*
COVID-19
Our Safety Measures
Patient Screening Form
Appointment Instructions and What to Expect
Contact Us
Patient Screening Form
Patient Info
Patient's Name
Patient's Age
Email Address
Phone Number
Preferred Contact Method
Email
Phone
Screening Questions
1. Do you have a fever or have felt hot or feverish anytime in the last two weeks?
Yes
No
2. Do you have any of these symptoms:
Dry cough, Muscle Aches, Shortness of breath, Difficulty breathing, Sore throat, or Runny nose?
Yes
No
(2b) If 'Yes' to above, please provide more detail:
3. Have you experienced a recent loss of smell or taste?
Yes
No
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?
Yes
No
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