COVID-19 Screening
Thank you for completing this screening prior to your appointment.  

IF YOU ANSWER "YES" to any of the following questions, please call (518) 288-8431 for further evaluation before coming to the office.

Thank you for wearing a mask at all times in the office. For the best protection, please choose a high-quality KN-95/N95 mask, or double-mask by using a surgical mask under your cloth mask.

**This survey has been updated as of 1.1.22. For the sake of our most vulnerable patients, WomanCare will maintain a 10 day period of caution after a positive Covid test, development of Covid symptoms, and/or known Covid exposure, despite recent changes in CDC guidance.  Thank you for your understanding and cooperation.
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Patient name *
1.  In the last 10 days, have you experienced any NEW symptoms of illness including: fever or chills, cough, shortness of breath, fatigue, muscle/body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or diarrhea? *
2.  Have you or a household member had a positive COVID-19 test in the past 10 days? *
3.  Have you been in close contact with a confirmed or suspected COVID-19 case? *
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