Patient Covid19 Screening

Appointment Request Form

 

Available in Chinese
(Traditional Han)
此問卷在右上角可選語言繁體中文

 

For health and safety of our staff and our community, we ask all patients requesting a dentist appointment to kindly fill the risk assessment form before their arrival to the clinic.  Please understand our staff will check again upon arrival at the clinic.  Thank you for your corporation during this pandemic period.
為確保診所的員工,醫師,以及區域居民的健康安全,我們會要求預約病患者在赴約來牙醫診所前請填以下“新冠肺炎檢疫表”。在您到達診所後,我們會再次做新冠肺炎健康確認。非常感謝您的合作。

We will contact you to arrange an appointment when we receive the form.
收到表格後我們會盡快與您聯絡。