Covid-19 Pre-Screening Questions

March 20, 2022 Update: The Ministry of Health continues to require that all patients are screened before being treated.

This screening questionnaire was adapted from the Ontario Ministry of Health Covid-19 Patient Screening Guidance Document (ver 5.0, August 26, 2021)

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.

Screening Questions

1. Did you receive your final (or second) vaccination dose more than 14 days ago?
   您的第二剂COVID-19疫苗注射是否已经超过14天？
2. Do you have any of the following symptoms:
   • Fever and/or chills
   • New onset of cough or worsening chronic cough
   • Shortness of breath
   • Decrease or loss of sense of taste or smell
   • If adult >18 years of age: unexplained fatigue/ lethargy/ malaise/ muscle aches (myalgias)
   • If child <18 years of age: nausea/vomiting, diarrhea您是否有以下症状：
   发烧，发冷，
   新出现的咳嗽，或慢性咳嗽加重，
   呼吸急促，
   味觉或嗅觉下降或丧失
   如果已满18岁：不明原因的疲劳，嗜睡，不适，肌肉酸痛
   如果未满18岁：恶心，呕吐，腹泻
3. Have you tested positive for COVID-19 in the past 10 days or have you been told you should be isolating?
   在过去的十天内，您是否被确诊为COVID-19 或者被要求自我隔离

   If you have NOT been fully immunized* (i.e. answered ‘No’ to Q1)…
   * A fully immunized individual is defined as any individual >14 days after receiving their second dose of a two-dose COVID-19 vaccine series or their first dose of a one-dose COVID-19 vaccine series (i.e .Johnson and Johnson).

4. Did you travel outside of Canada in the past 14 days?
   过去14天您有没有从加拿大省以外的地方回来？
5. Have you had close contact with a confirmed case of COVID-19 without wearing appropriate PPE?
   您是否在没有穿戴适当的个人防护装备的情况下与新冠病人有过密切接触？

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!