COVID-19 Wellness Check
For all of our safety, please fill this out prior to your appointment. Be sure that the information is accurate and complete. Please get immediate medical attention if you have any of the severe COVID-19 signs. If you answer "YES" to any of these questions you must reschedule your appointment.
In the past 14 days, I have experienced...
Fever 101°F +
Shortness of breath
Have you come into contact with any confirmed COVID-19 positive patients in the last 14 days?
Recent loss of sense of smell or taste
Non-allergy related runny nose
Have you had any GI upset/illness?
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