We value your comfort & safety. LEARN ABOUT OUR COVID PROTOCOLS
REQUEST APPOINTMENT
PAY

COVID-19 PRE-SCREEN FORM IN ABADIN DENTAL

COVID-19 Pre-Screen Form

"*" indicates required fields

First Name*
Last Name
MM slash DD slash YYYY
Please enter a number less than or equal to 100.
Do you/they have a fever or have you/they felt hot or feverish in the past 2 weeks (14-21 days)?*
Are you/they having shortness of breath or other difficulties breathing?*
Do you/they have a cough?*

Any other flu-like symptoms, such as gastrointestinal upset, headache or fatigue?*

Have you/they been in contact with someone confirmed with COVID-19 in the last two weeks?*

Patients who are well but who have a sick family member at home with COVID-19 should consider postponing elective treatment.
Do you/they have any pre-existing conditions, or auto-immune disorders (i.e. Heart Disease, Lung Disease, Kidney Disease, or Diabetes)?

MM slash DD slash YYYY
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.

MORE TO EXPLORE

MEET DOCTOR ABADIN
OUR SERVICES
FINANCING
SMILE GALLERY
PATIENT FORMS
CONTACT US
Request
Call
Map
General, Invisalign, Implant, Cosmetic and Family Dentistry in Coral Gables/Miami
QUICK LINKS
Facebook Google Twitter Instagram Yelp
OFFICE HOURS
























Contact Us Footer

"*" indicates required fields

Name*
This field is for validation purposes and should be left unchanged.

Privacy Policy: We hate SPAM and promise you to keep your email address safe Please call us at (305) 783-3750 if you have any problems with the form.
© 2023 ABADIN DENTAL  |  SITEMAP  |  PRIVACY POLICY Dental Marketing by WEB MARKETING FOR DENTISTS

Request Form

"*" indicates required fields

Name*
This field is for validation purposes and should be left unchanged.

Privacy Policy: We hate SPAM and promise you to keep your email address safe Please call us at 305-503-5864 if you have any problems with the form.
Skip to content