Skip to content
Waterloo Dentist – Waterloo Dental Centre Logo
  • HOME
  • PATIENT CENTRE
    • Patient Forms
      • New Patient Form
      • Medical History Update
      • 5-Year Medical History Update
      • Covid-19 Patient Screening Form
      • COVID-19 Pandemic Dental Risk Consent
  • SERVICES
    • Emergency Services
      • Emergency Dental Exams
      • Dental X-Rays
      • Cuts & Lacerations
      • Dental Root Canal
      • Dental Filling Cavities
      • Crowns & Bridges
      • Repair Broken Teeth, Fillings, Crowns & Dentures
      • Replacement Of Fillings & Crowns
      • Removal Of Foreign Bodies
      • Treatment Complications
    • Cleaning and Prevention
    • Complicated Tooth Extractions
    • Dental Restorations
    • Cosmetic Dentistry
    • Periodontal Disease
  • FOR STUDENTS
  • BLOG
    • News
  • SERVICE AREAS
    • Waterloo
      • Beechwood Waterloo Ontario
      • Beechwood West-Ontario
      • Clair Hills-Ontario
      • Colonial Acres-Ontario
      • Upper Beechwood-Ontario
      • View All Areas
  • Book An Appointment
  • HOME
  • PATIENT CENTRE
    • Patient Forms
      • New Patient Form
      • Medical History Update
      • 5-Year Medical History Update
      • Covid-19 Patient Screening Form
      • COVID-19 Pandemic Dental Risk Consent
  • SERVICES
    • Emergency Services
      • Emergency Dental Exams
      • Dental X-Rays
      • Cuts & Lacerations
      • Dental Root Canal
      • Dental Filling Cavities
      • Crowns & Bridges
      • Repair Broken Teeth, Fillings, Crowns & Dentures
      • Replacement Of Fillings & Crowns
      • Removal Of Foreign Bodies
      • Treatment Complications
    • Cleaning and Prevention
    • Complicated Tooth Extractions
    • Dental Restorations
    • Cosmetic Dentistry
    • Periodontal Disease
  • FOR STUDENTS
  • BLOG
    • News
  • SERVICE AREAS
    • Waterloo
      • Beechwood Waterloo Ontario
      • Beechwood West-Ontario
      • Clair Hills-Ontario
      • Colonial Acres-Ontario
      • Upper Beechwood-Ontario
      • View All Areas
  • Book An Appointment
Covid-19 Patient Screening Form
  • Covid-19 Screening Form

    Waterloo Emergency Dental Centre

    258 King Street North, Unit #7,
    Waterloo, Ontario, Canada N2J 2Y9
    Phone: (519) 883-0505

  • DD slash MM slash YYYY
  • If you are immunocompromised, select “No.”
  • • Fever and/or chills
    • Extreme tiredness
    • Cough or barking cough
    • Sore throat
    • Shortness of breath
    • Runny or stuffy/congested nose
    • Decrease or loss of taste or smell
    • Headache
    • Muscle aches/joint pain
    • Nausea, vomiting and/or diarrhea

    Select “No” if all of these apply:
    • You have completed your isolation period, or you tested negative for COVID-19 on one PCR test or rapid molecular test or two rapid antigen tests taken 24 to 48 hours apart, and
    • You do not have a fever, and
    • Your symptoms have been improving for 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea)
  • • You live with someone who is currently isolating because of a positive COVID-19 test
    • You live with someone who is currently isolating because of COVID-19 symptoms
    • You live with someone who is isolating while waiting for COVID-19 test results

    Select “No” if you:
    • are 18 or older and have received your booster dose, or
    • are 17 or younger and are fully vaccinated, or
    • completed your isolation after testing positive in the last 90 days (using a rapid antigen, rapid molecular, or PCR test)
  • • You live with someone who is currently isolating because of a positive COVID-19 test
    • You live with someone who is currently isolating because of COVID-19 symptoms
    • You live with someone who is isolating while waiting for COVID-19 test results

    Select “No” if you have already completed your isolation period because your symptoms started before your positive test result, and
    • you do not have a fever, and
    • your symptoms have been improving for 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea
  • All the patients will be asked to sanitize their hands when arriving at the office.
    Any “yes” response (other than Q1) must be discussed with the managing dentist immediately.
  • DD slash MM slash YYYY

About Our Dentist Office

Waterloo Dental Centre specializes in providing excellent emergency and non emergency dental care to patients in the Waterloo, Ontario area. Many dental problems need to be addressed immediately to prevent the condition from worsening, which is why it is our mission is to serve you as quickly as possible, to avoid any pain or increase in damage.

Waterloo Dental Centre

  • 258 King Street North, Unit #7
    Waterloo, Ontario, Canada, N2J 2Y9
  • (519) 883-0505
  • SMS (519) 904-4431
  • [email protected]

Quick Links

  • About Waterloo Dental Centre
  • Dental Services
  • Emergency Dental Services
  • Student Promotion
  • News
  • Contact Us
  • Review Us
CALL (519) 883-0505
© Copyright 2016 -    |  All Rights Reserved   |   Website & SEO by Digital Assault Media
Page load link
Waterloo Dentist Office | Waterloo Emergency Dental Centre

Go to Top