COVID-19 Pre-Screening Questionnaire

Stopping the spread of COVID-19 is a community effort; at Lenga Perio we are dedicated to providing an environment that is not only safe to treat patients, but also recognizes the importance of the health and safety of our team members. Please answer our COVID-19 Pre-Screening questionnaire using your best judgment prior to your appointment.


If you answer YES to ANY of these questions, please contact our office to reschedule your appointment.


With your help we will win against the spread of COVID-19.

COVID-19 Pre-Screening Questionnaire
*Factors such as old age, diabetes and end-stage renal disease are generally not considered immunocompromised. Examples of being immunocompromised include individuals: • undergoing cancer chemotherapy • with untreated HIV infection with CD4 T lymphocyte count less than 200 • with combined primary immunodeficiency disorder • on prednisone medication — more than 20 mg per day (or equivalent) for more than 14 days • on other immune suppressive medications. Highest-risk congregate care setting include, for example, long-term care home, retirement home, employer-provided living setting for International Agriculture Workers, hospital school, Education and Community Partnership Program.
*Do not select any of the above if you do not have a fever and your symptoms have been improving for 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea).