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COVID-19 Assessment Questionnaire

Our team is taking precautionary measures to protect you!

Please answer this form truthfully as this  will help prevent

the spread of COVID-19 Virus in our community.

 

Risk Factor Questionnaire

History of 2019 NCoV Exposure

Have you had close contact with Persons with confirmed case of Covid-19?
Have you had close contact with Persons Under Investigation (PUI)?
Have you had close contact with Persons Under Monitoring (PUM)?
If Yes, for how long each time?
Please indicate if you are experiencing the following symptoms:

      Thank you for submitting! Please give us time to assess.     

The clinic's representative will be in contact with you prior to your scheduled visit. Should your answers to the above questions change in the interim, please advise ASAP.

THE GROVE

2F Retail Row, The Grove By Rockwell,

E.Rodriguez Jr., Pasig

OPENING HOURS

The Grove, Pasig Branch

THE DENTIST IS IN

Tuesday - Saturday: 10:00am – 7:00pm

 

BY APPOINTMENT ONLY

Sunday & Monday

Contact us at 

8256-0791 | +63 977-6863662

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