Wisconsin Dental Improvements
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Select Page
  • Home
  • Services
    • Preventative Services
    • Restorative Services
    • Other Services
  • About Our Staff
  • Forms
    • Patient Registration
    • Medical History
    • Records Release
    • HIPPA Notice of Privacy
    • HIPPA Consent
    • HIPPA Authorization
  • Location
  • Pay Online
  • Membership Plan

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Associations

American Dental Association American College of Prosthodontists Mauston Chamber of Commerce Wisconsin Dental Association

Coverage Area

Juneau County, Northwest to Central Wisconsin

Privacy Guarantee

HIPAA Compliant

Payment We Accept

We Accept Cash, Check, Visa, MasterCard, Discover, CareCredit
Wisconsin Dental Improvements | 510 E State St, Mauston, WI 53948 | 608-400-0221 | Powered by Ziplocal | Sitemap

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General Covid-19 Screening Questionnaire

  • PREAPPOINTMENT CHECK

  • 5. Do you currently have (or have you experienced) any of the following symptoms in the past 21 days?

  • Some medical conditions have been associated with more sever COVID-19 disease. The Following questions are an attempt to determine your risk:

  • To the best of my knowledge, the questions on this form have been accurately answered. I understand that providing incorrect information can be dangerous to my (or patient's) health. It is my responsibility to inform the dental office of any changes in medical status.
  • This field is for validation purposes and should be left unchanged.