Online Check-In for West Sound Dentistry

Dr. Lisa Horschman

Use the form below to check-in for your appointment once you are in the parking lot. Please stay in your vehicle until we send you a text or call you that we are ready for your appointment.

- Step 1 of 5

Name *

First

Last

Phone *

Have you had any of the following symptoms in the last 30 days? *

Fever
Chills
Cough
Shortness of breath
Sore throat
New loss of smell or taste
None of the above

Do you still have the symptoms you checked above? *

Yes
No

When was the LAST TIME you had symptoms? *

Less than 10 days ago
More than 10 days ago

Have you received your primary series of the COVID vaccine? *

Yes
No

Are you up to date on your vaccine, (including the booster, if you are due)? *

Yes
No

Have you been exposed to a covid positive person in the last 10 days? *

Yes
No

Have you been tested for covid since exposure date? *

Yes
No

Did you have a positive covid result? *

Yes
No

By signing below, I acknowledge the above information is true to my knowledge. Your health and safety is our top priority. We are adhering to precautions outlined by the Center for Disease Control (CDC) and the Washington State Department of Health. A weak or compromised immune system (including, but not limited to, diabetes, asthma, COPD, cancer treatment, radiation, chemotherapy, and any prior or current disease or medical condition), can put you at greater risk for contracting COVID-19 and may result in the need to consider rescheduling treatment. At our office we continue to use Universal Precautions along with WISHA and CDC infection control protocols and standards, and we are trained to prevent the spread of infectious diseases such as the flu, HIV, hepatitis, and tuberculosis. These precautions that we take every day will also help prevent the spread of Coronavirus. The Coronavirus has a long incubation period. You or your healthcare providers may have the virus and not show symptoms and yet still be highly contagious. While we have taken additional precautions which enhance our safe treatment environment and further minimize the possibility of exposure, an increased possibility of transmission exists simply by being out in public, including a dental healthcare facility. *

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