COVID Questionnaire | Tree City Dental

By Appointment Only: Monday – Thursday 8am – 5pm | Friday 8am-2pm
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Dental Implants in Boise Idaho can help you smile with confidence again!

Our dentist can give you a dental crown matching the natural color of your teeth!

Achieve your most beautiful smile with advanced clear aligners!

Cosmetic dentistry in Boise, Idaho, can help you achieve your personal perfect smile!

Patient Information
Patient First Name
Patient Last Name
Prior To Appointment
Have you had a fever or felt ill in the past 2-3 weeks?
- Yes
- No
Have you experienced shortness of breath or difficulty breathing?
- Yes
- No
Have you experienced a cough or heaviness in your chest?
- Yes
- No
Have you had flu-like symptoms, gastrointestinal upset, headache, or fatigue?
- Yes
- No
Have you experienced loss of taste or smell?
- Yes
- No
Are you in contact with any COVID-19 patients?
- Yes
- No
Do you have any underlying health concerns, autoimmune disorders, diabetes?
- Yes
- No
Have you traveled in the past 14 days outside the immediate area?
- Yes
- No
Positive responses to any of these would likely indicate a deeper discussion with the dentist before proceeding with dental treatment.
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Today's Date
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Name
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Boise Dentist Covid Questionnaire