COVID-19 Safety Questionnaire

1 of 3: Has anyone who will be visiting the clinic experienced any of following symptoms in the past 48 hours?

  • Cough
  • Headache
  • Muscle aches
  • Loss of taste/smell
  • Chills
  • Sore throat
  • Temp > 100F
  • Runny nose
  • Trouble breathing
  • Diarrhea
  • Nausea