COVID-19 Questionnaire

  • Date Format: MM slash DD slash YYYY
  • In The Past 24 Hours, Have You Or Any Other Household Member Experienced:
  • If you answered "yes" to any of the symptoms listed above or a household member's temperature is 100.4°F (38°C) or above your appointment will be rescheduled. It is suggested that you self-isolate and contact your primary care physician's office for direction.

  • IN THE PAST 14 DAYS, HAVE YOU:
  • If you answered "yes" to either of these questions, your appointment will be re-scheduled. It is suggested that you self quarantine at home for 14 days.

  • The Air Doctors Will Follow Up After A 14 Day Waiting Period To Reschedule If You Need To Quarantine.
  • Date Format: MM slash DD slash YYYY