Revive Dental Covid Prescreen Form

Name *

First

Last

Date / Time *

Date

Time

Patient Screening Questions - Covid-19

2.) Have you been in contact with someone known to have tested positive with COVID-19? *

3.) Have you had any contact with laboratory samples known to contain COVID-19? *

4.) Have you been in a large group setting in Manitoba in the last 14 days? *

5.) Have you traveled outside of Manitoba in the last 14 days? *

6.) Are you or someone you live with a health care worker/first responder? *

7.) Do you or someone you live with work in a correctional facility,shelter,personal care home? *

8.) Has a member of your household been identified as a close-contact and instructed to self-isolate (quarantine) by public health officials,and they are not able to isolate from you? *

Slide

What Our Patients Say About Us

Dr. Shah is wonderful, he did an amazing job on my veneers! I finally have a smile that I love, for the first time in my life. The staff here are always so friendly and accommodating, and ever since I started coming here, I actually find myself looking forward to dental appointments! I highly recommend Westwood Dental

– LISA DARKWING

SEE ALL TESTIMONIALS

Where To Find Revive Dental At Westwood

3216 Portage Ave

Winnipeg, MB

R3K 0Y8

(204) 837-4517

Revive Dental Winnipeg

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone. Our scheduling coordinator will confirm your appointment.

Turn Your Camera On For Your Next Zoom Call

Reach out and discover all of the ways we can help make your smile whiter, straighter, and confidence worthy.