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COVID-19 Health Screening Questions
Before your appointment, please fill out and answer the following questions below:
Persistent cough
Yes
No
2.
Within the past 10 days, have you had any illness or symptoms such as, but not limited to:
Persistent cough
Yes
No
Shortness of breath
Yes
No
Higher than normal temperature (above 100.3ºf)
Yes
No
Higher than normal temperature (above 100.3ºf)
Yes
No
Submit Answers
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