COVID-19 Pre-Sceening Questions

Pre-Screening Questionnaire

The following is a COVID-19 (Coronavirus) pre-screening questionnaire that must be reviewed in advance of an appointment at Ziese Family Dentistry. Please review the questions and call our office if you answer “Yes” to any of these questions to determine if we should reschedule your appointment. Otherwise, we look forward to seeing you at your upcoming appointment.

Pre-Screening Questionnaire

  1. Does the patient/member of household have a fever or felt hot/feverish within the last 14-21 days?
  2. Does the patient/member of the household have shortness of breath or other difficulties breathing?
  3. Does the patient/member of the household have a cough?
  4. Does the patient/member of the household have any other flu-like symptoms, such as gastrointestinal upset, headache or fatigue?
  5. Has the patient/member of the household recently loss their sense of taste or smell?
  6. Has the patient/member of the household been in contact with any confirmed COVID-19 positive people?
  7. Has the patient/member of the household traveled in the past 14 days to any regions heavily affected by COVID-19?

Appointment Reminder Checklist:

  1. Please remember to complete your online patient forms prior to your arrival. Access to your forms can be found on your online patient portal located here.
    • If you’ve not yet created your patient portal, then please contact our office at (530) 622-2862 or via email at to activate your account.
      • You will need your email address, birthday and zip code to activate your account.
      • Please note that your email address should have NO capital letters and that your birthday should be in the following format: mm/dd/yyyy
  2. Upon arrival for your appointment, please park in our “parking-lot-lobby” and wait in your car.
    • Please text or call us at (530) 622-2862 to notify us of your arrival and a staff person will greet you at your car.
    • Please come to our front door if we do not respond within 5-minutes.
  3. Please be prepared for a forehead temperature check and a review of the COVID-19 pre-screening questionnaire before being escorted into the office.
  4. Please wear a mask while in the office unless treatment is being rendered.

We are working hard to keep you safe during this COVID-19 pandemic. Click here to find out more about the new technology and protocols that we have implemented at Ziese Family Dentistry to help mitigate the transmission of COVID-19.