Home » COVID-19 Pre-Screen Questionnaire

COVID-19 Pre-Screen Questionnaire

You’ll notice a few differences when you visit, but the care you receive won’t be one of them. Here are a few things you’ll see:

  • We will use no-touch mobile communications such as text, email and phone.
  • We will ask you to wait in your car and text us upon arrival.
  • Hand sanitizer is readily available.
  • Temperature checks help us screen everyone.
  • We’re using some new protective gear.
  • If you’re not feeling well, we can help you reschedule.

There are also a few things behind the scenes that might not stand out. Just a few include:

  • Added cleaning and disinfection of public spaces.
  • Continued strict sterilization monitoring.
  • More training than required on protective measures

Did we mention that we’re excited to see you? But before we do, please take a minute to fill out the pre-appointment screening and health history forms! Thank you.

Do you or have you had a fever of above 100 degrees in the past three days? *

Yes No

Have you recently lost or had a reduction in your senses of smell or taste? *

Yes No

Do you have a sore throat? *

Yes No

Do you have a dry cough? *

Yes No

Do you have a runny nose? *

Yes No

Have you been in contact with someone who has tested positive for or suspected they were positive for Covid-19 (corona virus?) in the last two weeks? *

Yes No

Have you tested positive for Covid-19 or are you awaiting test results for Covid-19 within the last 10 days? *

Yes No
By submitting the above form you agree and accept our Privacy Policy.*
Dr. Diem Do provides high-quality dental services

Dr. Diem Do set up his private practice after graduating from the University of New Orleans and LSU School of Dentistry. He follows continuing education for the benefit of his patients. Dr. Tami Nguyen is a graduate of Xavier University of Louisiana and LSU School of Dentistry. Both are members of top professional organizations like the American Dental Association and New Orleans and Louisiana Dental Associations. They are trusted and respected by the community for their high-quality dental services.

Start Your Journey Today!

You don't have to settle for feeling self-conscious about imperfections in your smile. If you are in the Marrero, LA area, Give Smile In Style, Diem Do DDS a call today at (504) 340-9400 to book a consultation.