COVID-19 Patient Screening

Please answer the following questions to ensure you are COVID-19 symptom free.

Patient Name *

Date *

It is important to closely monitor your health and the health of those you care for to help prevent the spread of COVID-19 and other illnesses like the flu.

1. Do You Feel Sick? *

Yes

2. In the past 48 hours, have you had, or are you currently experiencing;

Cough (New or Worsening) *

Yes

OR two or more of the following symptoms (new or worsening);

Fever (i.e. chills/sweats) *

Yes

Sore Throat *

Yes

Runny nose/nasal congestion *

Yes

Headache *

Yes

If yes, go home or stay home as noted above. Follow Public Health instructions for testing and isolation.

3. Have you recently visited a COVID-19 exposure site? *

Yes

4. Have you travelled in the past 14 days outside of the province and/or country AND been advised to self-isolate? *

Yes

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Welcoming New Patients

Looking for a dentist in Montreal South-Shore? Our dentists will be delighted to welcome and serve you.

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We are a proud member of
the network.

Hours

Monday: 08:00 am - 05:00 pm
Tuesday: 08:00 am - 05:00 pm
Wednesday: 08:00 am - 05:00 pm
Thursday: 08:00 am - 05:00 pm
Friday: 08:00 am - 04:00 pm
Saturday: Closed
Sunday: Closed

Contact

Centre dentaire Fancelli

560, chemin de Chambly bureau 100, Longueuil, QC J4H 3L8 CA

Phone

(450) 670-0021

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(450) 670-0021