COVID-19: Screening Questions

In order to ensure the safety of all our patients and team members we will be asking some screening questions when an appointment is made and/or confirmed and upon arrival to the office.

Patient Screening Form

1. Do you/they have fever or have you/they felt hot or feverish recently (14-21 days)?

2. Are you/they having shortness of breath or other difficulties breathing?

3. Do you/they have a cough?

4. Any other flu-like symptoms, such as gastrointestinal upset, headache or fatigue?

5. Have you/they experienced recent loss of taste or smell?

6. Are you/they in contact with any confirmed COVID-19 positive patients? Patients who are well but who have a sick family member at home with COVID-19 will need to postpone treatment.

7. Have you tested positive for COVID-19?

8. Have you/they traveled in the past 14 days?***


Positive responses will prompt your appointment to be rescheduled 4 weeks after all symptoms are gone and no presence of fever (without the help of medications) 

*** Positive response will prompt your appointment to be rescheduled 2 weeks after arrival from your trip

Testing Resources: a.,  b. Clear Choice MD Urgent Care (Portsmouth: 603-427-8539 / 750 Lafayette Rd. Portsmouth),  c. Rite Aid COVID testing

                                  We ask that all of our patients wear a mask for the appointment.


Thank you so much for your cooperation and we apologize for any inconvenience.