Pre-exam questionnaire 

Dear Patient; Prior to your appointment with us, a team member will ask you the following questions. 

We have posted a copy here. We are looking forward to seeing you on your appointment, and we want to make sure that you and the staff are safe.

If you answer "yes" to any question, click the box below question 7 and we will be in touch.

(1) Did you test positive for the coronavirus this year?                                            NO  YES

(2) Do you have a cough, fever or sore throat?                                                         NO  YES

(3) Are you, or a family member a health-care worker?                                           NO  YES

(4) Have you been working outside the home since March 15, 2020?                      NO  YES

(5) Have you visited a hospital or retirement residence in the past 3 weeks?         NO  YES

(6) Have you traveled outside the city in the past 3 weeks?                                    NO  YES

(7) Are you coming in as an emergency, with red eyes?                                           NO  YES

Contact the front desk: