COVID-19 PATIENT SCREENING QUESTIONNAIRE
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Do you have a fever, or have you felt feverish recently?
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Do you have a cough?
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Are you having shortness of breath or any difficulty breathing?
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Do you have chills or repeated shaking with chills?
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Do you have any muscle pain?
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Do you have any recent onset of headache or sore throat?
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Do you have any other flu-like symptoms?
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Do you have any recent loss of taste or smell?
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Have you experienced any recent GI upset or diarrhea?
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Are you in contact with anyone who has been confirmed to be COVID-19 positive?
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Have you traveled in the past 14 days to any regions affected by COVID-19?
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Have you had or diagnosed with COVID-19 positive within the last six months?
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Have you had any of the above described COVID-19 symptoms within the last six months, but not have been tested?
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If you answered "yes" to any Covid-19 questions, please call our office as soon as possible to discuss your responses. Thank you for helping us keep you and your family safe.
Kingston Family Cosmetic Dental Team
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