Arrival Directions for Patients Prescreening Treatment Questionnaire

Welcome to Partners In Dental Care.  We are grateful and ready for the opportunity to serve you today!  You will experience the highest level of protection and process to minimize the risk of exposure to all bacteria and viruses.

A copy of the Arrival Directions, Prescreening Questionnaire and Health History Update are located on the front door.

You have two “check in” options.

1) If you are more comfortable waiting in your automobile, please fill out the entry packet in your car, please call: 616.949.0230 to “Check In.”  A clinical team member will call your mobile phone when it is time to enter the building.  If you do not have a mask, one will be provided – please choose option #1.  If you have a condition that prevents use of mask, please choose option #1.  


2)  If you are more comfortable Social Distancing in the Lobby while wearing your own mask, please enter the building and check in with the Welcome Receptionist.  If choosing this option, please fill out the packet in the reception room. 

Please maintain Social Distancing at this entrance.  Thank you for keeping our campus optimally safe!

When your assigned Dental Assistant or Hygienists Afterwards is ready, she will meet you in the lobby to review your questionnaire, take your temperature, and escort you to the treatment room. 

Due to the high demand of necessary personal protective equipment (ppe), there will be an additional fee of $10 on your statement.  We are optimistic that this will be a temporary fee.  Please know we are doing everything we can to eliminate any added fees to your dental care in the Covid-19 era.

Patients not needing assistance will be asked to enter building alone.  Parents, legal guardians, or patient aids may accompany patients.  These guests may socially distance while wearing a mask in the reception room but will not be allowed in the Treatment Room.  If your guest does not have a mask, one will be supplied for them.  Alternatively, guests have the option, and are encouraged to stay in the car.

Partners in Dental Care – Pre-screening Treatment Questionnaire

1. Do you or have you had any of these flu-like symptoms in the last 14 days?                

Consistent Cough: Yes or No                         

Onset or changes in Shortness of Breath: Yes or No               

Or at least two of these symptoms?: Yes or No         

(Circle all that apply)
Repeated shaking
Muscle aches
Sore throat
New loss of taste or smell

2   Are you awaiting results of a lab test for COVID-19? Yes or No

3.  Have you tested positive for COVID-19? If so, when? Yes or No

4. Have you or a family member previously been asked to self-isolate or self-quarantine in the past 14 days? Yes or No

5.  Have you had close contact to an individual diagnosed with COVID-19 infection in the past 14 days? Yes or No

If “yes” to any of the above questions, delay elective treatment for 14 days, then re-evaluate.

Please contact our office (616-949-0230) if any changes in your health occur in the next 14 days.

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Schedule an Appointment

 Schedule an appointment with us by calling (616) 949-0230.