Skip to content
Search for:
EyeMax Covid Screener
Miguel
2020-12-16T16:14:43+00:00
EyeMax Covid Screener
1. Are you and/or anyone accompanying you today displaying any of the following symptoms?
Fever of 100.4 or higher
*
Yes
No
Cough
*
Yes
No
Shortness of breath or difficulty breathing
*
Yes
No
Repeated shaking and/or chills
*
Yes
No
Muscle pain
*
Yes
No
Headache
*
Yes
No
Sore throat
*
Yes
No
New loss of taste or smell
*
Yes
No
Runny nose (specific to kids under 18)
*
Yes
No
Diarrhea (specific to kids under 18)
*
Yes
No
Vomiting (specific to kids under 18)
*
Yes
No
2. Have you and/or anyone accompanying you today been in close contact with a person known to have COVID-19/Coronavirus?
*
Yes
No
3. Have you or and/or anyone accompanying you today traveled outside of the continental U.S. in the last 14 days?
*
Yes
No
IF YOU SELECTED YES TO ANY OF THE ABOVE QUESTIONS, PLEASE CALL OUR OFFICE at 859-272-1422.
******** Please check that you have read and understand the below.
Checkbox
*
Select All
Anyone over the age of 3 is required to wear a mask when entering our office. If you do not have your own mask with you today, we will provide you with one.
Patient temperature will be taken as well as anyone accompanying the patient prior to entry into the office.
Go to Top
