Ready to visit us?
We’re looking forward to seeing you.

COVID-19 Screening Form

Name*
First Last
Your Email*
Today's Date*
MM slash DD slash YYYY
Have you had close contact with anyone with acute respiratory Illness or travelled outside of Ontario in the past 14 days?*
- Yes
- No
Do you have a confirmed case of COVID-19 or had close contact with a confirmed case of COVID-19?*
- Yes
- No
Do you have any of the following symptoms:*
• Fever
• New onset of cough
•Worsening chronic cough
• Shortness of breath
• Difficulty breathing
• Sore throat
• Difficulty swallowing
• Decrease or loss of sense of taste or smell
• Chills
• Headaches
• Unexplained fatigue/malaise/muscle aches (myalgias)
• Nausea/vomiting, diarrhea, abdominal pain Pink eye (conjunctivitis)
• Runny nose/nasal congestion without other known cause
- Yes
- No
Are you 70 years of age or older, experiencing any of the following symptoms: delirium, unexplained or increased number of falls, acute functional decline, or worsening of chronic conditions?*
- Yes
- No
Consent*
I believe my answers to the above questions to be true and honest.
If there is a positive response to any of these, we would recommend discussing with the dentist and team before proceeding with any elective dental treatment. You declare all your answers to be true and correct. These questions will be reviewed and/or repeated at time of appointment. By clicking Submit you agree to these terms.

I have never seen a dental office like this before. Having recently moved to Toronto I was referred to Dr. Abbott by a friend. This office is full of fun people who really love their jobs and their patients. And Dr. Abbott is the most professional dentist I have ever met. Her knowledge and genuine interest in the well being of her patients is evident from the first visit. She even called me later that evening to see if I was okay as I had expressed concern about some gum pain. What dentist does that?

Sean G.

I have had Dr. Abbott as a dentist since she first started. I now live in Newmarket and travel to North York just to see her. Would not change dentists. She is very helpful and friendly and always has time for her patients. I have even recommended her to friends who are now patients of hers. The office staff are the best and always have a smile.

Vanessa R.

Ready to visit us? We’re looking forward to seeing you.

COVID-19 Screening Form

Ready to visit us?
We’re looking forward to seeing you.