COVID-19 Pre-Appointment Questionnaire
Please ask yourselves the following questions. If you can answer any of the following questions with a "Yes", we will need to reschedule your appointment. Additionally, I recommend that you contact a medical professional to seek further assistance.
Have you come in to close contact with someone who has been diagnosed with the coronavirus in the past 14 days? Yes No
Have you traveled out of the state or country in the past 14 days? Yes No
Have you come in to close contact with someone who has been diagnosed with the coronavirus in the past 14 days? Yes No
Have you traveled out of the state or country in the past 14 days? Yes No
Do you have any of these symptoms:
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Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No |