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Completion of your COVID-19 Patient Questionnaire

The CDC and OSHA have established guidelines for dental practices that include the completion of a Patient Questionnaire prior to any dental appointment. This form will need to be completed for each and every dental visit to ensure the safety of all patients, staff and doctors.


All of the information will be kept private and never provided to anyone for any reason other than required by law for tracking and tracing purposes.


This form needs to be completed 2 days prior to your dental visits. If the form is not completed we will not be able to provide treatment at that time. Of course, we will try to assist you in any way possible to make this as easy and as convenient as we can.


There are several ways to obtain this from online:

  1. You can CLICK HERE to obtain the form on any computer or cell phone.

  2. If you prefer you can go to our website for more information and then obtain the form on one of several pages. CLICK HERE

If you have any difficulties or have any questions please feel free to contact us at any time.


Dr. Ganz, Laura, Joanne, Casey and Iwona


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© 2017 by Cary Ganz DDS