“Dr. Chien is knowledgeable, professional, skilled and friendly. He is always patient and explain with you the root cause and care plan.” – Lina G. (August 2017)
FOR PATIENTS COMING IN FOR ROUTINE DENTAL CLEANINGS, PER RECOMMENDATIONS FROM THE AMERICAN DENTAL ASSOCIATION (ADA) AND CALIFORNIA DEPT. OF PUBLIC HEALTH (CDPH), DENTAL CLEANINGS ARE LIMITED TO HAND SCALING AND VERY MINIMAL POLISHING FOR THE TIME BEING. THIS IS IN ORDER TO LIMIT AEROSOLS AND SPLATTER DURING APPOINTMENTS. WE WILL STILL APPLY FLUORIDE AFTER THE CLEANING IF YOU ARE OKAY WITH THAT.*
IMPORTANT: Please review the following screening questions. If there are any questions that you would respond “YES” to, please give our office a call so we can discern if your appointment needs to be rescheduled.
DO YOU HAVE A FEVER OR ABOVE-NORMAL TEMPERATURE?:
ARE YOU EXPERIENCING ANY SHORTNESS OF BREATH OR HAVING TROUBLE BREATHING?:
DO YOU HAVE A DRY COUGH?:
DO YOU HAVE A RUNNY NOSE?:
HAVE YOU RECENTLY LOST OR HAD A REDUCTION IN SENSE OF SMELL OR TASTE? :
DO YOU HAVE A SORE THROAT?:
ARE YOU EXPERIENCING CHILLS OR REPEATED SHAKING WITH CHILLS?:
DO YOU HAVE UNEXPLAINED MUSCLE PAIN?:
DO YOU HAVE A HEADACHE?:
EVEN IF YOU DON’T CURRENTLY HAVE ANY OF THE ABOVE SYMPTOMS, HAVE YOU EXPERIENCED ANY OF THESE SYMPTOMS IN THE LAST 14 DAYS?:
HAVE YOU BEEN IN CONTACT WITH SOMEONE WHO HAS TESTED POSITIVE FOR COVID-19 IN THE LAST 14 DAYS?:
HAVE YOU BEEN TESTED FOR COVID-19 IN THE LAST 14 DAYS?:
IF YES TO ABOVE QUESTION, WHAT WERE THE RESULTS OF THE TESTING?:
HAVE YOU TRAVELED MORE THAN 100 MILES FROM YOUR HOME IN THE LAST 14 DAYS?:
ARE THERE ANY CHANGES IN YOUR HEALTH HISTORY SINCE YOUR LAST VISIT?:
If you have any questions and / or concerns, please give our office a call at (949) 379-1082 or email us back at any time. We appreciate your patience and understanding during these trying times.
“I have a good time at Dr.Chien’s office thanks to his and his staff friendly and attentive service. He even called me at evening to check my status after a day procedure.” – Ngoc T. (June 2019)
Please Note: Messages sent with this form is not considered private. Please call (949) 379-1082 if transmitting highly confidential info. Much appreciated!