COVID-19 QUESTIONNAIRE

Last updated: Jan 15, 2021

Please review these questions before your appointment.
If you answer YES to any of theses questions, please call the office at 518-758-7711 ext 0.

 

Question 1:

Are you or anyone in your household  subject to quarantine due to travel outside of New York. 
(New York State COVID-19 Travel Advisory Page)

Question 2:

In the past 14 days, have you developed any new symptoms of:

  • Cough, shortness of breath, difficulty breathing

  • Fever, chills, headaches

  • Sore throat, loss of smell or taste

Question 3:

Have you had close contact / suspect exposure with someone diagnosed with COVID-19?  Close contact means having been within 6 feet of that person for an extended time or being exposed to their cough or sneeeze.

Question 4:

Have you tested positive for COVID-19?