COVID-19 Questionnaire Name* First Last Email Enter Email Confirm Email Do you have any of the following: Fever or chills Cough Difficulty breathing or shortness of breathing Sore throat, trouble swallowing Decrease or loss of taste or smell Nausea, vomiting, diarrhea Not feeling well, extreme tiredness, sore muscles Have you had close contact with a confirmed or probably case of COVID-19 without wearing appropriate PPE? If you answered yes to any of the questions or are experiencing any of the symptoms listed above, please cancel your appointment and contact Telehealth. If you are not experiencing any of the listed symptoms and have answered NO to these questions please select the box below and select submit.I've answered NO to all of the above* Confirm Share this:TwitterFacebook
