COVID-19 Visitor Survey

Please answer the questions below BEFORE entering our facility. Once you hit SUBMIT, you will receive a response either giving you permission to come inside, or asking that you do not enter. Thank you for your compliance. The safety of our patients, family and employees is our highest priority.

Antes de entrar, todos los pacientes, visitantes y comerciantes tienen que llenar esta auto-evaluación para recibir permiso para entrar:

Within the last 10 days, have you tested received a positive test result for COVID-19? *

En los últimos 10 días, ¿ha dado positivo en la prueba de COVID-19? *

Within the last 10 days, have you had symptoms of COVID-19, which include: *

En los últimos 10 días, ¿ha tenido síntomas de COVID-19, que incluyen:*

Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea

Fiebre o escalofríos
Tos
Falta de aire o le es difícil respirar
Fatiga
Dolores musculares o corporales
Dolor de cabeza
Pérdida reciente de los sentidos del gusto y del olfato
Dolor de garganta
Congestión o moqueo nasal
Náuseas o vómitos
Diarrea

Within the last 10 days, have you had close contact with someone with COVID-19? *

En los últimos 10 días, ¿ha estado en contacto cercano con una persona con COVID-19?

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