378 Perkins St
Sonoma, CA 95476
Mon–Thu: 8:00 AM–5:00 PM
Fri: 8:00 AM–3:00 PM
3301 Villa Lane
Napa, CA 94558
Mon-Fri: 8:00 AM -5:00 PM
Are you fully vaccinated for COVID-19?
Do you have a fever or above normal temperature (>100.0 ̊ F)? Take temperature at appointment.
Are you experiencing more than one of the following symptoms: shortness of breath, dry cough, sore throat, unexplained muscle pain, headache or nausea, new loss of taste or smell?
Have you been near or had physical contact with anyone who has had these symptoms or has been diagnosed with COVID-19 in the past 14 days?
Even if you don’t currently have any of the above symptoms, have you experienced more than one of these symptoms in the last 14 days?
Have you been advised to quarantine due to close contact with someone diagnosed with COVID-19?
Have you been tested for COVID-19 in the last 14 days?
What is the result of the testing?
If still waiting on results, schedule appointment after results are known.
Have you traveled out of California in the last 14 days?
I agree to notify the dental practice if within 2 days I become ill with COVID-19 symptoms or test positive for COVID-19. I understand the dental practice has a legal and ethical obligation to inform me if a staff person I had close contact with tested positive for COVID-19 within 2 days.