COVID-19 Patient Pre-screening

Covid pre screening image

To prevent the spread of COVID-19 and reduce the potential exposure to our staff, patients and visitors, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone in our office. Thank you for your time.

Instructions

This questionnaire is to be completed by patients. If a patient is under the age of 18, please have your parent or legal guardian complete the form.

Please complete this questionnaire 24-48 hours before the scheduled appointment. For those who are completing this form, you agree to all the terms and conditions of this website or its third-party tools, which are necessary to its functioning and required to achieve the purposes of our office policies.