Fill out the Covid-19 Questionnaire

Covid Questionnaire
Do you have fever above 100.4 F *
Are you experiencing any of the following symptoms
A cough *
Shortness of breath *
Loss of taste of smell *
Any flu like symptoms such as upset stomach, headache, fatigue or pains *
Have you been in contact with someone who has tested positive for Covid-19 in the last 14 days *
Have you been tested for Covid-19 in last 14 days *
What is the result of the testing *
Have you travelled anywhere during the last 14 days? *
You have to be in quarantine for 14 days before you can come before coming for appointment
Are you over 60? *
Do you have any heart disease, lung disease, kidney disease, diabetes or any other auto immune disease? *