COVID-19 Questionnaire

Please confirm the answers to the questions below. Answers should be based on the last 24 hours.  If any of the answers to the statements below are YES, please reschedule. Thank you.

COVID-19 Questionnaire

  1. Are you presenting any of the following symptoms of COVID-19 listed below?
  • Temperature above 98.7 degrees
  • Shortness of breath
  • Loss of sense of taste or smell
  • Dry cough
  • Sore throat
  1. Have you been around anyone with these symptoms in the past 14 days?
  2. Do you live with anyone who is sick or quarantined?

Thanks for your time.