Appointment Pre-Screening Questionnaire

Viva Dental Wellness is taking every precaution to ensure we can continue to deliver quality dental care to our patients while following strict health & safety protocols.  If you have an appointment booked at Viva Dental Wellness, we kindly request you to review the Appointment Pre-Screening Questionnaire below. Please contact us if you have any questions or concerns.

If you answer “YES” to any of the below questions, please contact our clinic immediately at 780-760-8482 so we can discuss your upcoming appointment.

  • Do you have a fever or have felt hot or feverish anytime in the last 10 days?
  • Have you experienced a recent loss of smell or taste?
  • Have you returned from travel within Canada from a location known affected with COVID-19 in the last 14 days?
  • Have you returned from travel outside of Canada in the last 14 days?
  • Are you over the age of 65?
  • Do you have any of these symptoms: New or worsening cough? New or worsening shortness of breath? Difficulty breathing? Sore throat or painful swallowing? Runny nose?
  • Have you been in contact with any confirmed COVID-19 positive patients, or persons self-isolating because of a determined risk for COVID-19? (Healthcare workers who have worn appropriate PPE may answer No)
  • Is your workplace considered high risk? (Healthcare workers who have worn appropriate PPE may answer No)
  • Do you have any of the following? Heart disease, lung disease, kidney disease, diabetes or any auto-immune disorder?

If you answered “YES” to any of the above questions, please contact our clinic immediately at 780-760-8482 so we can discuss your upcoming appointment.