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Name*
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Do you have a fever or have you felt hot or feverish recently (past 14-21 days)?*
- Yes
- No

Are you having shortness of breath or other difficulties breathing?*
- Yes
- No
Do you have a cough?*
- Yes
- No

Any other flu-like symptoms, such as gastrointestinal upset, headache or fatigue?*
- Yes
- No
Have you experienced any recent loss of taste or smell?*
- Yes
- No

Are you in contact with any confirmed COVID-19 positive patients?*
- Yes
- No
Patients who are well, but who have a sick family member at home with COVID-19 should consider postponing elective treatment.
Are you over the age of 60?*
- Yes
- No

Do you have heart disease, lung disease, kidney disease, diabetes or any auto-immune disorders?*
- Yes
- No
Have you traveled in the past 14 days to any regions affected by COVID-19?*
- Yes
- No

Your Contact Information
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Date Format: MM slash DD slash YYYY

Preferred Appointment Dates
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Office Hours

Monday 8:00 am – 5:00 pm
Tuesday 9:00 am – 7:00 pm
Wednesday 8:00 am – 5:00 pm
Thursday 8:00 am – 5:00 pm
Every other Friday 8:00 am – 2 pm
Saturday Closed
Sunday Closed

About Us

My Family Dentistry in Powell TN puts “comfortable dentistry” at the heart of our practice. Dr. Wesley Mullins and his team provide compassionate care, experience, a gentle touch, and excellent dentistry that will make you want to be a patient of My Family Dentistry.

Location

My Family Dentistry
7714 Conner Road #102
Powell, TN 37849

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