Covid-19 Self Screening

Covid-19 Pre-visit Self Screening


Note: This tool is designed to assist patients in screening themselves for coronavirus prior to coming into the office. The self-screening is required for all patients visiting Clinical Associates. This screening will determine if it’s necessary to call your healthcare provider before traveling into the office for an appointment or procedure.  

Instructions: Please answer the following questions below. If you answer “YES” to any of the questions call your Clinical Associates Healthcare Provider for further evaluation prior to coming into the office for your scheduled office visit or procedure.

  1. Do you have any of the following symptoms? Fever, Chills, Muscle pain, Cough, Headache, Sore Throat, Diarrhea, Loss of taste or smell, Rash on toes, Difficulty Breathing, or Shortness of Breath?
  2. Have you had or have been scheduled to receive a COVID-19 Test within the last 2 weeks?
  3. Have you received a positive Covid-19 test within the last 2 weeks?
  4. Have you participated in a large gathering that would put you at high risk?
  5. Have you had any travel outside of the Mid-Atlantic area (MD, VA, WVA, DC, DEL, and PA) over the past 2 weeks?
  6. Did you answer “YES” to any of the above questions? If you answered “YES” to any of the questions please call the Clinical Associates Healthcare Provider with who you have an appointment to receive further evaluation before going into the office.  
CDC-Covid Self Assessment Tool

For patients who do not have a scheduled appointment but would like to screen themselves for Coronavirus, please visit the link below to the CDC's Screening Tool. 

Coronavirus Self-Checker