Tufts University School of Dental Medicine

COVID-19 Screening

To promote the safety of the community and reduce the impact of COVID-19, anyone visiting or returning to a Tufts University School of Dental Medicine facility is required to complete this form.

Please enter your email address:

Do you have a fever, chills, or feel feverish today?

Yes
No

In the past fourteen (14) days, have you been in close contact with someone who is confirmed as having COVID-19? (Note: health care personnel may answer “no” to this if contact occurred when appropriately protected by PPE in a clinical setting)

Yes
No

Are you experiencing new or worsened respiratory symptoms, such as a runny nose, sore throat, cough, or shortness of breath (those with symptoms known to be related to seasonal allergies may answer “no”)?

Yes
No

Have you had new occurrences of any of the following symptoms: loss of sense of taste or smell, muscle aches, diarrhea, nausea, vomiting, repeated shaking with chills, or a rash?

Yes
No

Current Progress 0%
0%	Current Progress 0%	100%