Covid-19 - McKinney Pediatric Dentistry

Emergency Dental Triage Form

How does it work?
Fill out the triage form below as accurately as possible. Please upload pictures (as good as you can take from your device) that will assist us in assessing the situation. Dr. Schaack will call you as soon as possible at the number you have provided below.

Triage Form

Patient's Name:

First Name

Last Name

New or Existing Patient?New PatientExisting Patient
Parent's Name

First Name

Last Name

Phone (the number where you would like your dentist to call you):

Email:

Changes in Medical History?YesNo
Select only if you are a current patient
If "Yes", Please Explain

Chief complaint now: (check all that apply)TraumaPain/SwellingOther
Please select the issue of concern. If this is an immediate emergency, and if you have not yet spoken directly with a staff member from our office, please immediately call 972-984-7890 and select option "2" to be connected to our on-call staff member who can address your situation in a more timely manner.
Please share relevant photos here that can assist us in addressing your concerns.
Picture 1 (Drop or upload your image here)
Picture 2 (Drop or upload your image here)
Picture 3 (Drop or upload your image here)
Picture 4 (Drop or upload your image here)

Description:

Describe the issue in detail

Please leave this field empty.

Emergency Dental Triage Form

Triage Form

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