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COVID Screening Questionnaires

Effective June 2, 2020 every patient and parent entering the office needs to complete the following questionnaire within 24 hours prior to the appointment.  If  you do not know your child’s medical record number, please put the name and birthdate.  If possible, please send back by email or fax several hours prior to the scheduled appointment.  If any answer looks concerning on the questionnaire, a physician will call you back to discuss whether the visit should be postponed.  Thank you in advance for your cooperation as we safeguard the health of our employees and patients.

COVID 19 PATIENT

COVID 19 ADULT

 

 

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