COVID-19 Screening Questionnaire


Although you may notice some changes in our office, we are committed to serving all of our patients and getting back to what we do best – making you smile!

The safety and health of our patients and staff has always been the highest priority in our office. Be assured that we have always followed the CDC guidelines for sterilization and infection control, and we are implementing additional standards and protocols. These changes are being made to ensure your health and safety while in our office. We appreciate your patience and understanding.

1. Please call our office at 614-457-6567 to check-in. We have implemented a new check-in process. When you arrive at our office, please remain in your vehicle. In order to reduce the number of people in our office at one time, we will notify you via phone or text when your room is ready. 

2. Please complete this screening questionnaire no more than 24 hours prior to your next appointment: COVID-19 Screening Questionnaire
(One form must be completed for each patient or parent that enters the office)

Parents are welcome to escort their children to the office. All individuals who enter our office (patients and parents) must complete a COVID-19 screening questionnaire and have their temperature taken before entering. 

3. There is limited seating in our reception area in order to maintain the necessary social distancing. When possible, we ask that you remain in your vehicle. Our staff are available to answer any appointment or financial questions. 

4. We kindly ask that you wear a mask while in our office. All staff members will be wearing masks. Clinical staff members will be wearing face shields as well. Although you may not be able to see our smiling faces, we remain committed to your care. 

5. Unfortunately at this time, the American Dental Association and Ohio State Dental Board are recommending that only patients be permitted in the clinic areas. This will allow us to maintain a safe 6 foot distance between patients. Parents are welcome to attend examinations and pre-treatment consultations in our private rooms. 

We look forward to seeing you soon!!

Cook & Mess Orthodontics

  • Columbus - 4775 Knightsbridge Blvd., Suite 201, Columbus, OH 43214 Phone: 614-457-6567
  • Upper Arlington - 2060 Arlington Ave., Columbus, OH 43221 Phone: 614-457-6567

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