Home
About Us
About Dr. Ho
Our Staff
Office Tour
Services
Family & General Dentistry
Regular cleaning and Annual Dental Examination
Root Canal Therapy
Extraction
Dentures
Children Dentistry
Cosmetic Dentistry
Crowns & Bridges
Inlay/Onlay
Composite Fillings
Teeth Whitening
Porcelain Veneers
Emergency
Invisalign
Botox Cosmetic
Zoom! Whitening
Intraoral Scanner
Before and After
Testimonial
New Patient
Contact Us
Survey
Schedule An Appointment
Write to us
We Are
Accepting New Patients
New Patient Form
1. Are you experiencing any of the following symptoms of COVID-19? Cough, sore throat, shortness of breath, muscle pain/body aches, runny nose, sneezing, loss of taste or smell, fever, nausea, extreme fatigue.
Yes
No
If you are experiencing symptoms, please contact our office to reschedule your appointment.
2. Have you been in close contact with a suspected or confirmed case of COVID-19 in the last 10 days?
Yes
No
If you answered Yes to the above question, please contact the office to discuss if there is a need to reschedule your appointment.
Name
*
Email Address
*
Date
3. I verify that the answers I provided on this form are truthful and honest. It is my responsibility to notify the office if any of the answers change before my appointment.
Yes
No
Please enter the office wearing a mask and we will ask that you use the hand sanitizer or washyour hands in the washroom when you arrive. Thank you.
Send Message
