COVID-19 SCREENING QUESTIONNAIRE
In response to the recent Coronavirus (COVID-19) outbreak and the raised pandemic alert status by the World Health Organization (WHO), Robert McDaniel MD is taking precautions to lessen the spread of the virus. All patients must have a screening form completed.
If answered YES to any of the above questions, your appointment will be rescheduled.
If you do not meet the criteria above, please sign below indicating that you have been provided with this information.
I HAVE REVIEWED THE ABOVE CRITERIA AND I DO NOT HAVE SYMPTOMS AS DESCRIBED.