COVID-19 QUESTIONS

Safety Precautions You Need To Know

COVID-19 Screening Questionnaire Required

 

Temperature Check

Masks Required

No Accompanying Guest at This Time

Signed Acknowledgement

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When you make your in-person appointment, we will require a COVID-19 Screening Questionnaire. To be screened for COVID-19, you will answer the following questions:

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• Do you have any of these symptoms?

  • Cough

  • Fever or chills

  • Shortness of breath or difficulty breathing

  • Muscle or body aches

  • Sore throat

  • New loss of taste or smell

  • Diarrhea

  • Headache

  • New fatigue

  • Nausea or vomiting

  • Congestion or runny nose

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• Does anyone in your house have COVID-19, or have you been in contact with someone who you know has COVID-19 or has had COVID-19 within the last 14 days?

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