Screening Questionnaire

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If you answer YES to any of the questions below please call Mosman Dental Centre directly: (08) 9383 3077

Surname:*

First Name:*

Phone (M):*

Email*

Have you been feeling unwell

Yes

OR have you had any of the following symptoms?

Fever or temperature now or in the past 3 days?

Sore throat, cough or shortness of breath?

Runny/stuffy nose or other respiratory symptoms?

Loss of smell or taste

When does your quarantine period end?

Have you been asked to self-isolate while waiting for COVID-19 test results?

Yes

ON ENTERING THE CLINIC IT IS RECOMMENDED:

SANITISE YOUR HANDS ON ENTERING AND LEAVING THE CLINIC

Our Policy on Cancellations & Failure to Attend

Short notice appointment cancellation, failed attendance or late arrival (of more than ten minutes) disrupts service for other patients and our staff. Due to our personalised care for our patients, and high demand for appointments at Mosman Dental Centre, the following Cancellation Policy applies:

When a patient cancels an appointment or does not attend, offering less than 48 hours notice:
- We understand that situations can happen (extreme weather, emergencies, traffic jams etc.) and we will NOT request a cancellation fee.
- However, for subsequent appointments, we may request a deposit in lieu of a short notice cancellation fee. The deposit will be requested to reserve a further appointment and be attributed to your future transactions.
Cancellations with less than 24 hours notice incur a short notice cancellation fee at the discretion of management.
Cancellation Fees are non-refundable.

Mosman Dental Centre reserve the right to request patients who continually cancel appointments at short notice, fail to attend, arrive late or are simply rude to source another service provider.

We exist to personally care for our patients and keeping to schedule is the only way we can continue to offer our quality service to all of our patients.