COVID-19 patient screening form

A COVID-19 screening form patients complete before an appointment. The cover letter asks them to return it by email before the visit, wear a mask on arrival, and stay home if they have symptoms such as cough, fever, chills, muscle pain, headache, sore throat, or new loss of taste or smell. It also lists warning signs that call for emergency care.

Use it when the office needs pre-visit screening, whether for COVID-19 or another outbreak. The front desk sends it with appointment confirmations and checks it before the patient is seated. Update the symptom list against current public health guidance first.