COVID-19 Screening Questionnaire

All clients will be pre-screened prior to scheduling an appointment in the CNIH Dental Clinic. An appointment cannot be scheduled if the client has not been reached in advance to be pre-screened. The following questions1 will be asked by clinical reception:

- Fever
- New onset of cough
- Worsening chronic cough
- Shortness of breath
- Difficulty breathing
- Sore throat
- Difficulty swallowing
- Decrease or loss of sense of taste or smell
- Chills
- Headaches
- Unexplained fatigue/malaise/muscle aches (myalgias)
- Nausea/vomiting, diarrhea, abdominal pain
- Pink eye (conjunctivitis)
- Runny nose/nasal congestion without other known cause

This is a living document and CNIH reserves the right to make amendments as needed.
2. “COVID-19 Patient Screening Guidance Document.” (2020). Ministry of Health. Retrieved from
http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_patient_screening_guidance.pdf

Scroll to Top