Opening Hours : Office will be closed until the COVID-19 shelter in place order is lifted except emergencies.


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650 964 6400


1174 Castro St. Suite 120

Mountain View, CA 94040

COVID-19 Pre-Visit Evaluation

  • Please fill out the screening questionnaire form and submit the day prior or the day of your appointment. Please don't print it out and bring to the appointment. If you are not able to fill in the answers, you can email in text format the answers for each question.
  • When you arrive to our parking lot, please text (650)964-6400 to check in for the appointment. We will text you when Dr. Rouleau is ready for the patient to come in. Please don't call to check in as text is most efficient.
  • If possible, we ask that the patient come in alone for the appointment. If a parent or guardian is required, we ask that just one person come in with the patient and wait in the reception area during the visit.
  • We ask that anyone coming into our office wear a face covering or mask. If you do not have one, please let us know and we will walk one out to the parking lot.
  • Please have your teeth brushed at home as we are no longer offering our brushing station.
  • When the patient comes into the office, we will provide hand sanitizer and take their temperature before the appointment.
  • After the appointment, we will let you know when the next appointment will be and will follow up with you to schedule closer to the appointment time.

Do you/they have fever or have you/they felt hot or feverish recently (14-21 days)?
Are you/they having shortness of breath or other difficulties breathing?
Do you/they have a cough?
Any other flu-like symptoms, such as gastrointestinal upset, headache or fatigue?
Have you/they experienced recent loss of taste or smell?
Are you/they in contact with any confirmed COVID-19 positive patients? Patients who are well but who have a sick family member at home with COVID-19 should consider postponing elective treatment.
Is your/their age over 60?
Do you/they have heart disease, lung disease, kidney disease, diabetes or any auto-immune disorders?
Have you/they traveled in the past 14 days to any regions affected by COVID-19? (as relevant to your location)
*Positive responses to any of these would likely indicate a deeper discussion with the dentist before proceeding with elective dental treatment.