REDLANDS OPTOMETRY GROUP, INC.
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COVID-19  SCREENING  QUESTIONNAIRE

This form will be updated as recommended by the CDC and California State Department of Health.  Last update May 5, 2020.
Your health and well-being are of the upmost importance and we are taking measures to keep the office a safe environment for employees as well as our patients.  Anyone visiting our office will be required to go through the screening process which includes answering this questionnaire, and have their temperature prior to entering our office.  You will also be required to wear appropriate face covering and maintain a safe social distance minimum of 6 feet. 
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If you are filling out the online version , it will automatically be transmitted to the office.  If you choose to print fill out the .pdf version, please bring with you at your next visit.  Please fill out within 24 hours of your visit, Thank You.

    COVID-19  Pre-Screening  Questionnaire
    (electronic version)
    ​Please answer the following questions:

    *Please note, if you answer YES to any of the questions above you will not be allowed into the facility/office per CDC and California Public Health COVID-19 guidelines.
    ​

Submit
COVID-19 Pre Screen Questionnaire (.pdf)

1020 Nevada St., Suite 202
Redlands, CA 92374
E-Mail: redlandsoptometrygroup@yahoo.com
Phone: 909-793-2106
Office Hours:
Monday - Thrusday 9am-6pm

Friday 9am-4pm
Saturday and Sunday Closed
Notice of Privacy Practices
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  • Home
  • Our Services
  • COVID-19 Screening
  • Patient Resources
    • Reorder Contact Lenses
    • Schedule An Appoinment
    • Eye Care Articles
    • Visioffice
    • NVision
    • Media
  • Contact