Covid Screening

About
Services
Covid Protocol
- Covid Screening
Appointment Check-in
Contact
Virtual Care

Covid Screening

We are taking proactive steps to ensure patients and care teams have a safe, clean environment. Please complete the following symptom screening on the day of your appointment prior to checking in.

Please fill out the form below prior to checking in on the day of your office visit.

* Indicates required field

Date *

To be completed on the day of your appointment

Name *

First

Last

Phone Number *

Email *

Do you have a fever or have you felt hot or feverish recently (14-21 days)? *

yes no

Are you having shortness of breath or other difficulities breathing? *

yes no

Do you have a cough *

yes no

Do you have other flu-like symptoms, such as gastrointestinal upset, headache or fatigue? *

yes no

Are you in contact with any confirmed COVID-19 positive patients *

yes no

Patients who are well but who have a sick family member at home with COVID-19 should consider postponing elective treatment.

Are you over the age of 60? *

yes no

Do you have heart disease, lung disease, kidney disease, diabetes or any auto-immune disorder? *

yes no

Have you traveled in the past 14 days to any regions affected by COVID-19 (as relevant to your region)? *

yes no

e-signature upon completion *

Submit

Positive responses to any of these would indicate a deeper discussion with the dentist before proceeding with elective dental treatment.

Oak Lawn Dental Center
6735 W 95th Street
Oak Lawn, IL 60453
708.598.0717

The office is located in Oak Lawn on 95th Street between Harlem and Central Avenue.

Hours of operation:
Monday: 10-5:30 Tuesday: 9-6 Wednesday: closed Thursday: 9-4 Friday: 9-3 Saturday: 8-1

We gladly accept the insurance plans listed below. If your plan is not listed, please call us at (708)-598-0717) as we are always adding new insurance plans.

About
Services
Covid Protocol
- Covid Screening
Appointment Check-in
Contact
Virtual Care