Screening Questionnaire

  • Dr. Peter Pessinis - General and Cosmetic Dentistry

    Patient Screening Form

    To be completed prior to appointment.

  • (Required if patient under the age of 18.)

  • Please note the following:

    • Upon arrival to the office, please sanitize your hands.
    • The receptionist will come around to check your temperature and ask the following pre-screening questions again once you are in the office.

  • This field is for validation purposes and should be left unchanged.