COVID-19 Pre-Screening Form
If you answer yes to any of the following questions: please call our office at (517)619-0300.
Have you or a member of your household had any of the following symptoms in the last 21 days:
- sore throat
- cough
- chills
- new body aches
- shortness of breath
- loss of smell
- loss of taste
- temperature of 100 degrees F or higher
Have you or a member of your household been advised to be tested for COVID-19 by your healthcare provider?
Have your or a member of your household been tested for COVID-19?
Have you or a member of your household visited or received treatment in a hospital, nursing home, long-term care, or other health care facility in the past 30 days?
Have you or a member of your household traveled outside of US in the past 30 days?
Have you or a member of your household traveled anywhere outside of mid-Michigan in the past 21 days. (i.e. another city/state)
Have you or anyone in your household cared for an individual who is in quarantine or is a presumptive COVID-19 positive patient?
Do you have any reason to believe you or a member of your household has been exposed to or acquired COVID-19?
COVID-19 Required Safety Protocols
Our office requires that all patients and visitors follow CDC guidance regarding face coverings to prevent the spread of COVID-19. Please wear a mask to your appointment. Please do not bring anyone into the building with you. If you need assistance with ambulating they can drop you outside the office door where we will meet them, and they can return to their vehicle. If someone needs to accompany you for any reason, please call ahead of your appointment for approval. Any person accompanying you will need to be screened and we will need have their cell phone number.
Please arrive no sooner than 5 minutes prior to your appointment time.