Please complete this screening survey before your appointment, and notify us if anything changes prior to your visit.

We also ask that you monitor your condition before your visit. If you are not feeling well or if you are running a fever (please check your temperature before arrival), we ask that you call us to reschedule your appointment. We also ask that patients come to the office alone, if possible.

Please contact us if you experience any of the symptoms associated with COVID-19 (coronavirus) within two weeks after your visit with us. You can view the CDC’s website with the symptoms here.

Contact us at 972-239-5757 if you have any questions or concerns. Thank you for your consideration as we work to keep everyone safe and healthy.

    Does the patient have a fever or felt hot/feverish in the last 2-3 weeks?
    YesNo

    Any shortness of breath or difficulties breathing?
    YesNo

    Does the patient have a cough?
    YesNo

    Any flu-like symptoms (upset stomach, headache, fatigue?)
    YesNo

    Any loss of taste or smell?
    YesNo

    Any contact with confirmed COVID-19 patients? (If so, please consider postponing your appointment.)
    YesNo

    Does patient have heart disease, lung disease, kidney disease, diabetes or any auto-immune disorders?
    YesNo

    Has patient traveled outside of North Texas to any other regions affected by COVID-19 in the last two weeks?
    YesNo