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COVID-19 Screening
Complete each time you meet in person. Please remember to wear your mask and keep a safe distance.
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Today's Date
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Your answer
Have you experienced any of the following symptoms in the past 48 hours: • fever or chills• cough• shortness of breath or difficulty breathing• fatigue• muscle or body aches• headache• new loss of taste or smell• sore throat• congestion or runny nose• nausea or vomiting• diarrhea?
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YES
NO
Required
Within the past 14 days, have you been in close physical contact (6 feet or closer or at least 15 minutes) with a person who is known to have laboratory-confirmed COVID-19 or with anyone who has any symptoms consistent with COVID-19?
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YES
NO
Required
Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19?
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YES
NO
Required
Are you currently waiting on the results of a COVID-19 test?
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YES
NO
Required
If you answered YES to any of the questions above, please cancel today's session and wait until you hear from us to reschedule.
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