COVID Screening Form

Use this form if your appointment is TODAY. You will likely be outside the office waiting to enter, but you can also complete this just before you leave. This is not to be used when confirming a future appointment (i.e. patient pre-screening). In that case, use this form.

If you would prefer to complete this screening another way, or are having technical difficulties, please phone our office during regular business hours (found on this page).

Step 1 of 5

Please read each question carefully. Multiple people may be screened using this 1 form.

New patients are always welcomed with a smile!

You don’t need a referral from your dentist.

Get a complete consultation with Dr. Grubisa at no charge.

Not quite ready? Read more about becoming a patient.

online or by phone

Les nouveaux patients sont toujours accueillis avec le sourire!

Vous n’avez pas besoin de référence de votre dentiste.

Obtenez une consultation complète avec Dr. Grubisa sans frais.

Pas tout à fait prêt? En savoir plus sur comment devenir d’un patient.

En ligne ou par téléphone