COVID-19 SCREENING QUESTIONNAIRE
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This form will be updated as recommended by the CDC and California State Department of Health. Last update May 5, 2020.
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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.
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.
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