7060 Warden Ave., Building C1, Unit3, Markham, Ontario, L3R 5Y2

North Warden Dental Centre

Covid-19 Pre-Screening Questions

This screening questionnaire was adapted from the Ontario Dental Association (ver 2.0, June 2020)

You will be asked the following questions by our staff when…

  • You book your appointment
  • We contact you to confirm or remind you of your appointment (usually 24-48 hours before)
  • You arrive at our clinic and sign the forms in-person.


  1. Do you have a confirmed case of COVID-19?
    您是否被确诊为 COVID-19?
  2. Have you had close contact with anyone with acute respiratory illness, or persons self-isolating because of a determined risk for COVID-19, or a confirmed COVID- 19 positive patient?
    您是否与患有急性呼吸道疾病的患者或与有 COVID-19 风险或被确诊为 COVID-19 阳性而自我隔离的人保持密切联系?
  3. Have you travelled outside of Ontario in the last 14 days?
  4. Have you had a fever, or have felt hot or chills anytime in the last two weeks?
    在最近两个星期,您是否发烧或感觉发烧或发冷 ?
  5. Do you have any of these symptoms: New onset of cough, Worsening chronic cough, Shortness of breath, Difficulty breathing, Sore throat, Difficulty swallowing, Decrease or loss of sense of taste or smell, Headaches, Unexplained fatigue/malaise/muscle aches (myalgias), Nausea/vomiting, diarrhea, abdominal pain, Pink eye (conjunctivitis), Runny nose/nasal congestion without other known cause?
  6. Are you 70 years of age or older, and experiencing any of the following symptoms: delirium, unexplained or increased number of falls, acute functional decline or worsening of chronic conditions?
    您是否已70岁或70 岁以上,并且出现以下任何症状:谵妄,无法解释的跌倒或跌倒次数增加,急性功能下降或慢性病的恶化?

If you answered YES to any of the above questions, one of our dentists will call you to determine how to manage your care.

Thank you for your cooperation!

We are dedicated to giving each of our patients the healthy smile they deserve!