COVID-19 Screening Questionnaire

In an Effort to Stay Safe and to Stay Open, We Need Your Help.

Please answer the following questions regarding your potential exposure to COVID-19

MM slash DD slash YYYY
Do you have a fever or any other COVID symptoms?(Required)
Have you had a positive COVID test in the past 30 days?(Required)
Are you awaiting COVID test results?(Required)
Are you currently in a school or work quarantine?(Required)
Do any of the above apply to someone in your household?(Required)
As a healthcare facility, we will continue to wear masks longer than non-healthcare facilities. Please be patient and considerate as some of our patients may have health conditions that prohibit vaccination and they may be at higher risk for COVID-19.
Thank You for Your Continued Understanding and Cooperation, Dr. John, Dr. Terri, & the Entire Anderson Eyecare Team
This field is for validation purposes and should be left unchanged.

Following the guidelines of the CDC and the American Optometric Association, we will continue our modified COVID-19 protocols. Please be patient as we incorporate these new recommended protocols to enhance your safety.
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