Downloadable COVID-19 screening form for dental patients

May 12, 2020
This downloadable dental patient screening questionnaire for COVID-19—developed by Scott Froum, DDS—is designed to ascertain possible exposure and those patients who demonstrate the highest risk of disease severity.

People with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), which causes the disease COVID-19, have displayed a variety of symptoms ranging from zero to severe. In addition, the mean incubation time for this disease is 5.1 days, with the onset of symptoms occurring two to 14 days after exposure.1

This patient screening questionnaire is designed to ascertain possible exposure and those patients who demonstrate the highest risk of disease severity. This screening process should be implemented 24 hours prior to the patient appointment and then repeated the day of the appointment. We also recommend that you follow up with your patient post-appointment (the author suggests a 10-day time interval) to determine if any changes have occurred. 

Click the Download button below to retrieve the form.

Reference
1. Symptoms of coronavirus. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. Centers for Disease Control and Prevention. Updated May 8, 2020. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html