Essence Dental Covid-19 Health Declaration

How are you feeling today?  Please complete this form no more than 48 hours before your scheduled appointment.

  • Fever and/or chills

  • New onset of cough / Worsening chronic cough

  • Shortness of breath

  • Decrease or loss of sense of taste or smell

  • If adult > 18 years of age : unexplained fatigue / lethargy / malaise / muscle aches (myalgia)

  • If child < 18 years of age : nausea/vomiting, diarrhea

If you cannot submit this form, please call the office directly.