Total Care Dental COVID-19 Pre-Screening Questionnaire

We are excited to have the opportunity to welcome you back to Total Care Dental! Our office has always utilized personal protective equipment (PPE) that has exceeded all the CDC guidelines, however, in light of the COVID-19 Pandemic we have instituted additional guidelines and protocols to ensure your safety.  Part of our enhanced protocols requires that we complete this questionnaire prior to your appointment. We will have to reschedule your appointment if we are unable to complete this step.

Please fill out this short questionnaire 48-72 hours before your appointment.  If you have questions, please feel free to call our office at (608) 274-1911.

  • On the day of your appointment, please arrive 5-10 minutes prior to your scheduled appointment to minimize waiting times.
  • Please wear a mask as you enter the practice.
  • You will be greeted by a team member to take your temperature upon entry.  
    • If you have a temperature >100ºF, you will be asked to reschedule your visit.
  • Please limit your personal belongings.  Please come by yourself, if you need an escort, please limit it to one additional person.
  • We will have limited seating in the waiting room.
  • Fever
  • Chills
  • Repeated shaking
  • Fatigue
  • Muscle aches
  • Vomiting
  • Headache
  • Sore throat
  • New loss of taste or smell
  • Malaise
  • Nausea
  • Diarrhea

Our primary concern is to protect the health and wellness of you as well as our team. We ask everyone to complete and submit our screening survey before coming into our office. Thank you for your patience and stay safe.

  • On the day of your appointment, please arrive 5-10 minutes prior to your scheduled appointment to minimize waiting times.
  • Please wear a mask as you enter the practice.
  • You will be greeted by a team member to take your temperature upon entry. 
    • If you have a temperature >100ºF, you will be asked to reschedule your visit.
  • Please limit your personal belongings.  Please come by yourself, if you need an escort, please limit it to one additional person.
  • We will have limited seating in the waiting room.