• COVID-19 Pre-Screening Questionnaire

    Due to the ongoing Covid-19 Pandemic, all patients are required to complete this form prior to being seen at Alzein Pediatrics Urgent Care.
  • Please answer the following questions below:

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  • Are you, caregiver or anyone in the household currently experiencing any of the following symptoms?

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  • By signing below, you certify that the answers above are true and that there is no information being withheld.

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