Patient Screening Form
Please read this form and sign where indicated. Use this form to screen patients before their appointment and when they arrive for their appointment.
Adapted from Dental Association of PEI COVID-19 Pandemic Emergency Dental Risk Acknowledge by Patient
Vancouver BC
555 W 12th Ave #5
Vancouver, BC V5Z 3X7
Call anytime between 8 am – 8 pm Monday –
Friday & 8am – 5pm Saturday PST