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COVID-19 Screening Form

We, at Clinton Dental Clinic,  are required to ask COVID-19 screening questions in advance of your appointment.


If you answer YES to any of the following questions, please contact our office 519-482-9392.


1) Have you tested positive for COVID in the last 10 days?


2) Have you been in close contact with a confirmed case of COVID in the last 10 days without wearing PPE?


3) Have you or anyone in your household been instructed to self-isolate?


4) Do you have ANY of the following cold, flu or COVID symptoms:

* Fever

* Onset of new cough

* Difficulty breathing

* Sore or scratchy throat

* Chills

* Headache

* Runny nose/nasal congestion not related to allergies

* Nausea, vomiting, diarrhea


Arrive to your appointment only a few minutes early for screening.


We look forward to seeing you at your dental visit and brightening your smile.

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