Pre-Screening Questions

Please answer the following questions:

1) Have you recently travelled by airplane within or outside of the US?

2) Have you or anyone in your household had any of the following symptoms in the last 21 days:

• New or worsening cough
• Shortness of breath
• Mild or moderate difficulty breathing
• Fever or chills
• Fatigue
• Sore throat
• Muscle or body aches (not attributable to exercise)
• New loss of smell, taste, appetite
• Nasal congestion or runny nose
• Nausea or vomiting
• Diarrhea

3) In the last 14 days, what is your known exposure to others who have had COVID-19?

4) Have you or anyone in your household been tested for COVID-19?

5) Do you have any reason to believe you or anyone in your household has been exposed to or acquired COVID-19?

6) To the best of your knowledge have you been in close proximity to any individual who tested positive for COVID-19?

7) Do you work in a high-risk environment?

If you said yes to any of the above questions, please explain and contact our clinic as soon as possible.