Oak Hill Dental Group
272 SW Bentley Place
Lake City, Florida 32025
(386) 752-3043

OAK HILL DENTAL GROUP –386-752-3043

272 SW Bentley Place

Lake City, FL 32025

oakhilldentalgroup@gmail.com

Positive responses to ANY of these would likely indicate a deeper discussion with the dentist before proceeding with elective dental treatment.  If there are ANY “YES” answers, PLEASE CALL THE OFFICE TO CONFIRM YOUR APPOINTMENT AND/OR RESCHEDULE IF NECESSARY.

Have you previously tested positive for COVID-19,                                        Yes      No

IF YES,  had subsequent negative tests?                                                           Yes      No

Do you have fever or have you felt hot or feverish recently(14-21 days)?                 Yes      No

Are you having shortness of breath or other difficulties breathing?                                    Yes      No

Do you have a cough?                                                                                           Yes      No

Any other flu-like symptoms, such as gastrointestinal upset, headache or fatigue?   Yes          No

Have you experienced recent loss of taste or smell?                           Yes    No

Are you in contact with any confirmed COVID-19 positive patients?          Yes    No

Patients who are well but who have a sick family member at home with COVID-19 should consider postponing elective treatment.

Is your age over 60 and you feel unsafe in public?                                         Yes     No

Do you have heart disease, lung disease, kidney disease, diabetes or any auto-immune disorders?                                                                                                                        Yes     No

Have you traveled in the past 14 days to any regions significantly affected by COVID-19? (as relevant to your location)                                                                                         Yes      No

If all answers are “NO” you may electronically confirm your appointment.  
PLEASE REPLY TO THIS EMAIL WITH A YES TO CONFIRM OR A NO TO CANCEL either by email or text that you were sent regarding your appointment.

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