The questions on this form are adapted from the American Dental Association. We ask that all patients fill this out prior to their appointment and understand that the same questions will be asked upon arrival.
Positive responses to these questions does that mean the patient will not be seen, but that further discussion with Dr. Stephens will need to happen.
This is to ensure the safety of our staff and patients. If any questions or concerns arise, please call us at (479) 442-3915 or email us at
stephensdentistry@gmail.com.
All responses to this form remain private under HIPAA regulations and information on those can be found at our website at
scottstephensdentistry.com under "Forms" or visit
www.hhs.gov for more information.