COVID-19 Screening Questionnaire

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COVID-19 Screening Questionnaire

Our families, staff and community mean a great deal to us and your safety is our top priority! During the COVID-19 pandemic, we have instituted a screening process. Please complete this questionnaire prior to entry into our office.

Your responses will be kept confidential and will be reviewed by a practice clinician who will provide guidance regarding any adjustments to the patient’s scheduled appointment.

Your information will be encrypted.