We Remain Open During the Lockdown
COVID-19 (Coronavirus) Screening
Questionnaire & Patient Acknowledgement Form
At Shoreham Dental, the health and safety of our patients and staff has always been our top priority. To
ensure we are providing the safest environment possible to deliver dental care, we kindly ask you to please
complete this brief questionnaire prior to your appointment. This has been mandated by the Royal College of Dental
Surgeons of Ontario for everyone’s safety. We appreciate your help and understanding with this measure.
If the answer to any of the following questions is YES, please inform our reception staff IMMEDIATELY for further instruction. Thank you.