COVID Screening Form

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Have you had a fever >100.0º in the last 14 days?(Required)
Have you had shortness of breath or difficulty breathing?(Required)
Have you had a cough?(Required)
Have you had any flu-like symptoms in the past 14 days? (nausea, vomitting, muscle aches, headach, fatigue)(Required)
Have you been exposed to anyone with COVID-19 symptoms in the last 7-10 days?(Required)
Have you recently lost taste or smell?(Required)
Are you over the age of 60?(Required)
Do you have any chronic medical conditions? (asthma, diabetes, heart conditions, auto-immune diseases, kidney problems, recent cancer treatments, etc.)(Required)
Have you traveled outside of the state in the last 14 days?(Required)

Positive responses to any of these questions might require us to reschedule your appointment.

For more information about COVID-19 (including testing sites), please see: https://health.utah.gov.

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We warmly invite you to experience exceptional care at our practice. Our facility is designed with your comfort and convenience in mind, featuring modern amenities and a welcoming atmosphere. Our dedicated team is here to provide personalized attention and address all your needs with professionalism and compassion.

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