COVID-19 Health Screening


If you are visiting our office during the COVID-19 pandemic, you will be screened for symptoms and exposure using the questionnaire below.

1. Have you experienced a fever of 100.4 degrees F or greater, a new cough, or shortness of breath within the past 10 days?
□ No. Go to the next question.
□ Yes. No further screening is needed. Visitor may not be admitted.

2. In the past 10 days, have you gotten a positive result from a COVID-19 test that tested saliva or used a nose or throat swab? (not a blood test)
□ No. Go to the next question.
□ Yes. No further screening is needed. Visitor may not be admitted. 

3. Are you subject to any quarantine or self-quarantine requirement, including as a result of a visit in the last 14 days to any of the states listed on the governor’s quarantine order?
□ No. Go to the next question.
□ Yes. No further screening is needed. Visitor may not be admitted. 

4. To the best of your knowledge, in the past 14 days, have you been in close contact (within 6 feet for at least 10 minutes) with anyone while they had COVID-19 or symptoms of COVID-19 (fever, cough, or shortness of breath).
□ No. Visitor may be admitted.
□ Yes. Visitor may not be admitted.