Dear Patient: in order to protect your health and your family’s health we are following the guidelines of the CDC and ADA and kindly request that you fill up this questionnaire two days prior to your appointment, and the day of your appointment.
  • Date Format: MM slash DD slash YYYY

  • Please answer the following questions.

    Patients who are well but who have a sick family member at home with COVID-19 should consider postponing elective treatment.
  • Thank you for your understanding, we look forward to seeing you soon, Dr. Grauer and Team.