DR THIERRY MEYER
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Adresse - Horaires
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Les Soins
urgence dentaire
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Sante bucco-dentaire
Conséquences sur l' état général
Parodontite
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Inlays et Onlays
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Covid19 -
Health certificate before dental cares
Thank you to complete this form prior to an appointment during the current sanitary context,
Regular patients and new patients are welcome. We need to prioritize and schedule according to this period.
We'll be in touch with you asap. Meanwhile , stay well & be safe . Thank you for your understanding.
In the event of symptoms related to Covid-19 for yourself or someone close to you, please cancel your appointment either directly by your Doctolib account or by email
:
[email protected]
*
Indique un champ obligatoire
First name - Last name
*
Prénom
Nom
[object Object]
Your age
*
Phone
*
E-mail
*
Your last appointment in our dental office
*
Less than one year
More than one year
First time , I am a new patient
How can we help you ? Your main concern :
*
Have you had Covid-19 yourself or someone close to you?
*
Yes
No
In the 14 days prior to this questionnaire, have you had yourself or somone close to you any of the following symptoms:
*
none
loss of taste
loss of smell
fever > 38°C
flu-like symptoms
shortness of breath
difficulty breathing
sore throat
cough
runny nose
Patient at high risk category, including: diabetes, cardiovascular disease,
hypertension, lung diseases including moderate to severe asthma, being immunocompromised, having
active malignancy, or over age 65... You can have dental cares if your medical doctor agrees or after we chat together.
Your health
*
I consider myself in a high risk category but I don't wish to report my dental cares anymore
I consider myself not in a high risk category
Do you have an allergy to Iodine ? ( or to seafood...)
*
Yes
No
By sending this form , I verify the information I have provided is truthful and accurate. If any change occurs, I will inform the dental office before my appointement
*
I understand and I confirm
Envoyer
Accueil
Le cabinet
Dentiste Aix en Provence
Adresse - Horaires
Notre approche
Photos
Honoraires
Play Lists
Esthetique
Un beau sourire
>
Quizz sourire
Citations sur le sourire
Facette dentaire
Facettes ceramiques
Facettes Lumineers
Emax ou Lumineers
Facettes immediates
Blanchiment des dents
>
Questions-Réponses sur le blanchiment des dents
Blanchiment des dents - Aix en Provence
Simuler votre sourire avec une application iPhone
Photos avant-apres
Les Soins
urgence dentaire
Parcours de soins
Prevention
>
Sante bucco-dentaire
Conséquences sur l' état général
Parodontite
>
Quizz Paro
Couronne dentaire
Bridge dentaire
Appareil dentaire
Rehabilitation totale
Inlays et Onlays
Bruxisme
Bouche sans metal
Implant dentaire
Implant Dentaire Aix en Provence
Implant dentaire Avantages
Implants Dentaires Informations
ENGLISH
Dentist Aix en Provence
Book Dentist Appointment
Contact us
Practice Tour
Porcelain veneers
Teeth Whitening
Inlays & Onlays
Clean Up Teeth Cleaning
Periodontal Disease
Dental Implant
Teeth Grinding
English Speaking Dentist Aix en Provence
Contact