Patient Covid-19 Screening Questionnaire
Are you currently experiencing, or have you experienced in the past 14 days, any of the following symptoms? (Please take your temperature before you answer this question.) *
Fever (100.4° F/37.8° C or greater as measured by an oral thermometer)
New loss of taste or smell
Shortness of breath or difficulty breathing
Nausea, diarrhea, vomiting
In the past 14 days, have you been in close proximity to anyone who was experiencing any of the above symptoms or has experienced any of the above symptoms since your contact?
In the past 14 days, have you been in close proximity to anyone who has tested positive for COVID-19?
Traveled in the last 14 days?