In order to ensure your safety, and the safety of our staff, we need you to complete this form 2 days prior to your appointment. 
We will confirm that we have received this form when your appointment is confirmed. 
When you arrive, you need to stay in your car and either call or text us. We will then let you know when you can come for your appointment. Please make sure to wear your mask and gloves. If you do not have a mask or gloves, we will be happy to supply them for you. 
Thank you in advance for your cooperation. Stay Safe!
Dr. Ganz, Laura, Joanne, Casey and Iwona.

New York State Quarantine Guidelines

  • Travelers Must Get Tested Within Three Days Prior to Landing in New York, Quarantine for at Least Three Days Upon Arrival, and Get a Test on Day Four of Arrival

  • If Travelers Receive a Negative Test On Day Four of Quarantine They May Exit Quarantine When They Receive Negative Result

  • States that are Contiguous with New York Continue to Be Exempted from Quarantine Protocol — Essential Workers Also Continue to be Exempted

  • Travelers Who Were Only Out of State for Less Than 24 Hours Do Not Need to Quarantine but Must Get a Test on Day Four of Arrival Back in NY

  • All Travelers Covered by The Advisory Must Continue to Fill Out Traveler Health Form Upon Arrival Into New York State

If You Prefer To Complete This On Your Cellphone Just Scan or Take A Photo Of This QR Code, Fill Out The Form and Click Submit. 
 wufoo Covid Form qr-code.png
If needed here if a Free QRCode Reader for the iPhone 
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© 2017 by Cary Ganz DDS