COVID Pre-Screen

Your health and safety always rank #1 with us.

You’ll notice a few differences when you visit, but the care you receive won’t be one of them. Here are a few things you’ll see:

We will use no-touch mobile communications such as text, email and phone.
We will ask you to wait in your car and text us upon arrival.
Hand sanitizer is readily available.
Temperature checks help us screen everyone.
We’re using some new protective gear.
If you’re not feeling well, we can help you reschedule.

There are also a few things behind the scenes that might not stand out. Just a few include:

Added cleaning and disinfection of public spaces.
Continued strict sterilization monitoring.
More training than required on protective measures

Did we mention that we’re excited to see you? But before we do, please take a minute to fill out the pre-appointment screening and health history forms by clicking below! Thank you.

COVID-19 Pre-Screen Questionnaire

First Name *

Last Name

Phone *

Email *

Do you or have you had a fever of above 100 degrees in the past three days? *

No

Yes

Have you recently lost or had a reduction in your senses of smell or taste? *

No

Yes

Do you have a sore throat? *

No

Yes

Do you have a dry cough? *

No

Yes

Do you have a runny nose? *

No

Yes

Have you been in contact with someone who has tested positive for or suspected they were positive for Covid-19 (corona virus?) in the last two weeks? *

No

Yes

Have you tested positive for Covid-19 or are you awaiting test results for Covid-19 within the last 10 days? *

No

Yes

I agree that the practice may send me Patient Care Related Messaging at the number I provided above. I understand my consent is not required for purchase. Messages Frequency will vary. Msg & data rates may apply. Reply HELP for help or STOP to cancel.