Temperature Monitoring And Screening Questionnaire

You must be afebrile, without a fever, to be treated. Please answer all of the following questions as accurately as possible.

  1. If you answer yes to any of these questions, you cannot be treated and need to consult with your primary care physician for Covid-19 testing!
  2. If you have tested positive Covid-19 and remain aferile and have no related Covid-19 symptoms over the past 10 days, then you maybe treated for our services today.
  3. If you answer yes to any of these questions, then you are at an added risk of developing Covid-19 with a potential serious outcome!
  4. Please sign and acknowledge that your answers are correct, that you have no additional questions, and you consent to the procedure(s) being performed today.