You have come to our office today for a routine medical evaulation and/or treatment that will be done during the COVID-19 pandemic. Please be advised of the following:
While our office completes the State Health Department and the Centers of Disease Control and Prevention infection control guidelines to prevent the spread of the COVID-19 virus, we cannot make any guarantees.
Our staff is symptom-free and, to the best of their knowledge, has not been exposed to the virus.
However, since we are a place of public accomodation, other persons (including other patients) could be infected, with or without their knowledge.
In order to reduce the risk of spreading the COVID-19 virus, we have asked you a number of screening questions below. For the safety of our staff, other patients, and yourself, please be truthful and candid in your answers.