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Patient Screening Form

COVID-19 Patient Letter and Screening Form

July 1, 2020

Dear Patients:

We hope this letter finds you and your family in good health. Our communities have been through a lot over the last few months, and all of us are looking forward to resuming our normal habits and routines. While many things have changed, one thing has remained the same: our office’s safety.

Infection control has always been a top priority in our practice. We follow recommendations and guidelines made by the American Dental Association (ADA), the Centers for Disease Control and Prevention (CDC), and the Occupational Safety and Health Administration (OSHA). Following these recommendations will ensure that our infection control procedures are up-to-date and that we provide the safest environment for our patients and staff members.

You will see changes at your next visit to our office. We made these changes to protect our patients and staff. For example:

On the phone before your appointment, we will ask you to fill-out the form online and submit it to us prior to your appointment. If you don’t have an ability to submit online, we will ask you some pre-screening questions and send you a questionnaire in the mail. This questionnaire must be completed, mailed and received before you arrive at the office.

The Pre-appointment Patient Screening questionnaire is available 2 ways:

  1. Send an email at LHeinemann@hohokusperio.com or call us at 201-652-0080, and we will mail you the questionnaire.
  2. Click to download the form, print, complete and mail the questionnaire to us so that we receive it prior to your appointment.

Upon entering the office:

  • Please wear a mask.
  • Your temperature will be taken.
  • We have hand sanitizer that we will ask you to use.

Appointments will be managed to allow social distancing between patients. This may limit the options for scheduling. We ask that you be patient and we will do our best to accommodate scheduling requests.

We will postpone treatment for any patient who has experienced or been in contact with someone who has experienced the following symptoms within 14 days of the scheduled appointment date: fever, cough, loss of taste and/or smell, flu-like symptoms, difficulty breathing or shortness of breath, and fatigue.

We look forward to seeing you again and will be happy to answer any questions you may have about the steps we have taken to keep everyone safe in our practice. We will be calling patients shortly to reschedule appointments that were cancelled during the last three months. We will be scheduling appointments starting the last week of July.

Thank you for being our patient and we value your trust and loyalty.

Best regards and stay safe,

Michael Voskian, DMD