Patient Screening Form[Online]

May 19, 2020

Dear Patient:

We hope this letter finds you and your family in good health. Our community has been through a lot over these past few months, and all of us are looking forward to resuming our normal habits and routines. The staff at Nichols Family Dentistry have spent these past months taking continuing education courses, participating in webinars regarding the Covid-19 pandemic and researching what should be added to our office to provide an environment that will allow us to provide quality care in the days ahead. 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, and you may have seen this during your visits to our office. Our office follows infection control recommendations made by the American Dental Association (ADA), the U.S. Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA). We follow the activities of these agencies on a regular basis so that we are up to date on any new rulings and guidance that may be issued. We do this to make sure that our infection control procedures are current and adhere to each agencies’ recommendations.

As of today, we are scheduled to reopen under Phase II of the Massachusetts Reopening Plan, on June 8, 2020. We will be phasing in dental care based upon the receipt of all the protective equipment that we have ordered. These items are above and beyond the minimum standard guidelines because we believe that each additional step we can take in preventing risk of transmission is in the best interest of our Staff and our Patients.

You will see some changes when it is time for your next appointment. We made these changes to do all we can to protect our patients and staff, and although there is never a 100% guarantee, we are confident that our additional protocols and equipment will offer everyone a comfortable environment in which to return to prevention and needed treatments.

  1. Prescreening/Screening:
    Prior to your next appointment, you will be asked to complete a pre-screening questionnaire. If you answer yes to any of these questions, please notify us. We will call you until the questionnaire is available on our website. These questions will be repeated when you arrive for your appointment and your temperature will be taken.
  2. Social Distancing and Hand Hygiene:
    When you arrive at the office the day of your appointment, notify us by phone or text message. Please stay in your vehicle until we call you in. Please sanitize your hands before entering the reception area. No more than 2 patients will be allowed in the waiting room at a time. PLEASE BE ADVISED THAT FAMILY MEMBERS ARE NOT PERMITTED TO ACCOMPANY YOU FOR YOUR APPOINTMENT, except for minors who will be allowed only 1 parent/guardian and those requiring medical assistance. Magazines, other reading materials, beverages, token prizes and the treasure chest have been removed at least in the interim to limit surfaces.
  3. Sanitizing and disinfecting:
    Appointment times have been adjusted to allow for a limited number of patients in the office, allow for better social distancing, and add extra time for additional sanitizing.
    Aerosols: These are particles that are released into the air during restorative procedures and with the use of polishing instruments, air and water spray, and ultrasonic cleanings.
    We have purchased high volume suction units for all restorative procedures and high-volume suction attachments for hygiene cleanings. Until the doctor’s suction units arrive, there will be no cleanings on the same day as restorative appointments. We will be adding Wednesdays to our schedule for only hygiene appointments. Until the hygiene suctions arrive, preventative appointments will not include ultrasonic scaling, the use of air/water spray rinsing or polishing.
    We have also purchased air purifiers with H13 true HEPA filtration to filter out potentially contagious particles from the air. At regular intervals, the office will be sprayed down with an EPA registered disinfectant.
  4. PPE (Personal Protective Equipment):
    All persons entering the office will be required to wear a face mask. Make sure both your nose and mouth are properly covered. We recommend placing it in a plastic bag for protection during treatment.
    All staff will be wearing scrubs and masks. Hygienists, Assistants, and the Doctor will be wearing protective gowns, respirator grade masks covered by another mask, face shield, safety glasses and gloves. They will also be required to answer screening questions and have their temperature taken before starting each shift.
    Our staff has been trained on the proper procedures for putting on and taking off all PPE.

Finally, though we will not be scheduling 100% right away, we have made the following changes to our business hours: Monday 8am-8pm; Tuesday 7am-4:30pm; Wednesday (hygiene appointments only) 9am-6pm; Thursday 8am-8pm; Friday 7am-4:30pm; Saturday 8am-2pm (appointments with the Doctor only). We hope the additional hours will assist in getting everyone back on track. We will have staff in the office for a portion of each day to answer phones and schedule appointments.

We sincerely hope that this detailed explanation of our new procedures will make you feel comfortable resuming your dental care and that we will see you in the office soon. We will attempt to contact patients that had to cancel an appointment to get you rescheduled as quickly as possible. We thank you for your patience and we truly value your trust and loyalty. On behalf of my staff, I want to welcome you back and look forward to resuming our quality care because you are important.


Eugene B Nichols, DMD

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8:00 am-6:00 pm


7:00 am-4:30 pm


9:00 am-6:00 pm


8:00 am-6:00 pm


7:00 am-3:00 pm