COVID-19 Form - STEP If you develop symptoms prior to your appointment please call us to re schedule.First Name* Last Name* Do you have a cough?* Yes No Do you feel short of breath?* Yes No Do you have a high temperature?* Yes No Do you have a sore throat?* Yes No Have you been in contact with a patient with COVID19 in the last 14 days?* Yes No Have you been in a nursing home in the last 14 days?* Yes No HiddenAdministrative-email Δ
