COVID-19 Screening

COVID-19 Screening Form

For the health and safety of all our patients, your visit to Backhus Family Dentistry will include a temperature reading and the following important screening questions.

Screening questions

  • Have you had a fever within the last 14-21 days?
  • Are you having shortness of breath or difficulty breathing?
  • Do you have a cough?
  • Have you experienced a recent loss of taste or smell?
  • Have you been in contact with any confirmed COVID-19 positive patients?


View a downloadable version of our COVID-19 Screening Form.