In-Home LCSW Employee/ Client Covid Screening
Please answer the following questions before entering the office. If you answer YES to any of the following questions, please stay home.
Email address *
Full name *
Have you (and/or your child) experienced a fever of 100.4 or greater, a new cough, new loss of taste or smell or shortness of breath within the past ten days? *
In the past ten days have you (and/or your child) tested positive for Covid-19? *
To the best of your knowledge, have you (and/or your child) been in close contact with someone who tested positive for Covid-19? *
In the past 14 days, have you (and/or your child) traveled internationally or returned from a state identified by New York State as having widespread community transmission of Covid-19? *
A copy of your responses will be emailed to the address you provided.
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