Please complete the following YES or NO questionnaire within 12 hours of your appointment time. Completion of this questionnaire is a mandatory requirement for your in-person appointment. Please contact the clinic if you are unable to use this assessment tool.
Clinic Access Approved
OK to proceed.
Valid for: 2023-12-03 09:11:52
Please show this screen or print off to show staff at the facility entrance
IF ANY ANSWERS CHANGE PLEASE CONTACT THE CLINIC PRIOR TO ARRIVAL TO DETERMINE ELIGIBILITY.
Thank you for helping us protect you and others during this time
Access: Not Approved
Please contact the front desk immediately so that we can clarify your unique situation.
DO NOT PANIC - We need to get more information from you and have multiple options to ensure
the patient gets the care they need