COVID-19 Health Screening Form
Download, print and complete this form. Bring it with you to your appointment.
We hope this letter finds you and your family in good health. Our community has been through a lot over the last few months, and all of us are looking forward to resuming our normal habits and routines. While many things have changed, one thing has remained the same: our commitment to your safety.
Infection control has always been a top priority for our practice. Infection control protocols are maintained to ensure you receive care that is both safe and comfortable.
Our office follows infection control recommendations made by the American Dental Association (ADA), the U.S. Center for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA). We follow the guidelines of these agencies to remain up-to-date on new rulings and guidance. You may see some changes when it is time for your next appointment.
? Please wear a mask/face covering.
? You’ll be asked health screening questions & your temperature taken when you arrive to the office.
? We will have hand sanitizer or a hand washing station that we will ask you to use when you enter the office.
? We are taking extra steps to sterilize and sanitize between patients to limit the spread of any infectious diseases.
? We will be conducting daily temperature checks on staff, parents/legal guardians, and patients.
? Our waiting room will no longer offer magazines, children’s toys, as those items are difficult to clean and disinfect.
? Appointments will be managed to allow for social distancing between patients.
? We will do our best to allow greater time between patients to reduce waiting times for you, as well as to reduce the number of patients in the reception area at any one time.
Please print, complete, and sign this COVID-19 HEALTH SCREENING FORM for yourself or a minor child (under the age of 18) and bring to the appointment.
Thank you for being our patient. We value your trust and loyalty and look forward to welcoming back our patients, neighbors, and friends.
24 W. 21st Street, Suite 104
Northampton, PA 18067
Phone: (610) 262-5511
Email: click here
Monday and Wednesday 9 a.m. to 6 p.m.
Tuesday and Thursday 8:30 a.m. to 5:30 p.m.
Roginsky Dental is located in the heart of Northampton, PA, at 24 W. 21st Street, Suite 104.
We serve patients throughout the Lehigh Valley, including Northampton, Walnutport, Coplay, Whitehall, Allentown, Bethlehem, Easton, and surrounding regions.