COVID-19 Info




Please click below to fill out the form one day before  your appointment. This needs to be filled out prior to every appointment until further notice. We truly appreciate your cooperation during these changing times.


Existing Patients: Fill out only Part A skip to Part C. You can add siblings to one form if we are seeing them on the same day.

New Patients: Fill out the form in its entirety

** In order to provide the best quaility care and safety of our patients, please note that we are adhering to the Chicago and Cook County restrictions. If the patient or anyone in the household has attended a gathering of more than 50 people such as holiday get-togethers (excluding school), or has returned from out of state listed on the orange list, we ask that you do not schedule your next appointment until you have been home for 10-12 days (unless the patient is fully vaccinated). We also ask if the patient or anyone in the household has returned from college or out-of-town school to wait 12 days before coming in for an appointment. **



We hope that all of you are in good health and have adjusted to the new normal. Although there have been many changes over the past few months, our commitment to your safety and well-being remains the same. We will continue to deliver the highest quality of care while implementing new protocols and procedures to ensure the safety of our patients, families and staff.  

Infection control has always been a top priority in our office. We are following guidelines recommended by the American Dental Association (ADA), the Centers for Disease Control (CDC), the Occupational Safety and Health Administration (OSHA) and the Illinois Department of Public Health (IDPH). We will continue to monitor these agencies to stay up-to-date on any new guidance they release.

The following outlines some of the new protocols we have implemented:

  • Daily health screening of our staff
  • Mandatory pre-screening of each patient prior to arriving to appointments 
  • Modified patient schedule that will accommodate 6-feet social distancing in the clinic
  • Mandatory masks for anyone entering the office
  • Temperature reading of anyone entering the office using a non-contact infrared thermometer. Anyone with a temperature over 100 degrees Fahrenheit will not be seen that day.
  • Modified drop-off / pick-up of patients
  • Installation of air purifiers with medical grade filters in strategic areas
  • Enhanced disinfection protocols throughout the office
  • Specialized Personal Protective Equipment (PPE) worn by all staff – we may look different but it’s still us!
  • Procedures requiring a high-speed handpiece will now be performed with our a new extraoral suction machine to further minimize any aerosolization

To further ensure the safety of everyone, we will be accepting payments over the phone. Any recurring charges and payments can be set-up with our staff.

We will continue to update everyone by email and text of any additional changes as we all adjust to this new normal. Please go to patient login at and confirm that we have your most updated contact information. As always, please feel free to call us directly with any questions you may have. We deeply value your trust and look forward to seeing you soon!

Best regards,

Dr. Shoel Kerzner and Staff

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