Are you pleased with the general appearance of your teeth and smile?*
Heart or heart valve problem*
High blood pressure*
Haemophilia or prolonged bleeding*
Asthma*
Diabetes*
Epilepsy*
Hepatitis or HIV*
Liver, kidney or thyroid problems*
Serious illnesses or operations*
Heart surgery*
Other medical problems*
Any other allergies?*
Are you taking any medication?*
Have you ever had any serious trouble associated with dentistry?*
Do you smoke?*
Are you pregnant?*
1) Do you have the following signs and symptoms?*
Cough
Fever
Shortness of breath
Runny nose
Pain - throat/head/body
Vomitting / diarrhea
Feeling generally unwell
2) Have you travelled to China, Japan, Hong Kong, South Korea, Iraq, Singapore or Italy in the last 28 days?*
3) Have you cared for or come into contact with an individual known or strongly suspected to have CoronaVirus within last 28 days?*
Note: if your answer is yes to either No.1 or No. 2, along with any of the signs and symptoms please ask for mask from the reception. You will be assisted to the isolation room while waiting for the doctor to see you for further assessment and management
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