Do you, your child, or any persons accompanying your child on their appointment day answer “YES” to any of the following questions?

1. Currently have a fever or have felt hot or feverish recently (within last 14-21 days)?

2. Have shortness of breath or other difficulties breathing?

3. Have a cough?

4. Any other flu-like symptoms, such as gastrointestinal upset, headache, or fatigue?

5. Have you recently experienced the loss of taste or smell?

6. In close contact with individuals exhibiting any of the above symptoms or in contact with any confirmed COVID-19 positive patients?

7. Have heart disease, lung disease, diabetes, or autoimmune disorders?

8. Have you traveled in the last 14 days in or out of states lines on any mass transit systems (airplane, trains, buses, etc.)?

9. Participated in a group gathering within the last 14 days where social distancing was not practiced?