Patient Screening Form

Please fill out this mandatory screening form based on the new guidelines established by the NB Dental Society.

1. Do you have a fever or have felt hot or feverish anytime in the last two weeks?
2. Do you have any of these symptoms: Dry cough? Shortness of breath? Difficulty breathing? Sore throat? Runny nose?
3. Have you experienced a recent loss of smell or taste?
4. Have you been in contact with any confirmed COVID-19 positive patients, or persons self-isolating because of a determined risk for COVID-19?
5. Atlantic Canadians will be able to travel to and from New Brunswick without the requirement to self-isolate but will be asked to provide proof of their province of residence. Visitors from other Canadian provinces and territories must self-isolate for 14 days upon arrival and may then travel within the Maritime provinces. Have you been outside of the Maritime provinces lately, and if so have you self-isolated for 14 days?
6. Do you have any of the following? Heart disease, lung disease, kidney disease, diabetes or any auto-immune disorder?