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?*YesNoDo you feel short of breath?*YesNoDo you have a high temperature?*YesNoDo you have a sore throat?*YesNoHave you been in contact with a patient with COVID19 in the last 14 days?*YesNoHave you been in a nursing home in the last 14 days?*YesNoAdministrative-email