COVID Screening Form

Use this form when your appointment is NOT today. If your appointment is today and you are outside the office, or will be here shortly, 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 3

Please read each question carefully. This screening is only required for the patient, not anyone who may be accompanying them to their appointment.

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