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7937 Granville St, Vancouver, BC V6P 4Z3 CA
(604) 266-5300

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South Granville Dentistry

COVID-19 Patient Screening

All patients are required to complete the following questions before their appointment and prior to commencing any recommended dental procedures.

Certain dental procedures create aerosols which are one way that the novel coronavirus can spread. Your answers to the following questions will help our clinical team ensure a safe environment for both patients and staff.

IMPORTANT: If the patient is not able to affirm any of the questions below a consultation with his or her Dentist will need to occur prior to the commencement of any appointments.

Patient Name *

Patient Age *

Parents or Legal Guardians Name if Patient is a Minor:

1. Have you (or the patient if a minor) tested positive for COVID-19 in the past month or are you waiting for results from COVID19 testing? *

Yes

2. Have you (or the patient, if a minor) been in contact with any person who has been diagnosed with COVID-19 in the last 5 Days? *

Yes

3. Have you (or the patient if a minor) been advised by your physician or provincial health authority to individually quarantine due to a possible exposure to COVID-19? *

Yes

2. Do you have or have you recently had (within the past 5 days) any of the following symptoms (or the patient if a minor):

Fever above (37 degrees Celsius) or feeling hot, chills/feverish *

Yes

Repetitive or chronic coughing *

Yes

Shortness of breath or difficulties breathing *

Yes

Sore throat or painful swallowing *

Yes

A loss of taste or smell *

Yes

General or specific muscle pain not normally experienced *

Yes

General flu like symptoms including a runny nose, upset stomach, diarrhea or headache *

Yes

3. Have you (or the patient if a minor) been in contact in the past 5 days with anyone with confirmed COVID-19 or with any of the above symptoms of possible COVID-19? *

Yes

4. Have you (or the patient if a minor) travelled in the last 5 days to any areas significantly impacted by COVID-19 *

Yes

5. In the past 5 days, have you (or the patient if a minor) been to any large gatherings where social distancing was not observed? *

Yes

6. Do you (or the patient if a minor) have heart, lung or kidney disease, diabetes, or any auto-immune disorders? *

Yes

By clicking here and printing my name below, I confirm that I know there are categories of people who are considered to be at high risk. I understand the high-risk category factors are being 65 years of age or older, heart disease, lung disease, kidney disease, diabetes or any auto-immune disorder. If I (or the patient I am completing this form for) are in one of these categories I have chosen to proceed with my (or the patients) appointment knowing the risk to my (or the patients) health if I (or the patient) develop COVID-19. I confirm that if there are any changes to the above answers from the time I complete this form to the time of my (or the patient in the case of a minor) appointment, I will let the office know.

Please Type the First & Last Name of Person Completing This Form *

Spam Blocker

Is dental sedation safe?

Whether you are due for a routine cleaning or oral surgery, visiting the dentist may cause you a great deal of anxiety. Today, our Vancouver dentists share some information about dental sedation, whether it is safe and how it can help make your visit stress-free.

Should I try charcoal toothpaste?

Charcoal toothpaste has become one of the most popular trends in dental care, but is it a trend that you should follow? Here, our Vancouver dentists share some of the ways that charcoal toothpaste could potentially cause more harm than good and what you can do instead to achieve a healthy and bright smile.

Looking for a dentist in Vancouver?

We are always happy to accept new patients to our dental clinic! With a comprehensive range of dental services, South Granville Dentistry can help you maintain and protect your oral health. Get in touch with us today to book an appointment.

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The dental office is owned and operated by Dr. Suphattra Lertruchikun and/or her professional corporations. Copyright © 2023 South Granville Dentistry - Dr. Melissa Lin & Associates. All Rights Reserved.

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