• Aesthetic Plastic Surgery 905 Fifth Ave., New York, NY10021 Phone:(929)505-2060

  • COVID-19 Screening Questionnaire

  • 1. Do you have:

  • 9.Have you experienced the following symptoms (Appear 2-14 days after exposure to the COVID19 virus):

    i. Fever (100.0°F)
    ii. Dyspnea, cough, or other respiratory symptoms
    iii. Shortness of breath
    iv. Muscle aches/pain
    v. GI symptoms (nausea, vomiting, diarrhea)
    vi. Loss of appetite
    vii. Loss of taste or smell
    viii. Conjunctivitis
    ix. Chills / repeated shaking with chills
    x. Extreme fatigue
    xi. Blue discoloration/ blisters of toes
    xii. Age > 65 confused, dizzy, falls, mental status changes

    If you answered yes to any of these questions, please call your primary care provider or your State Department of Health for further direction.

  •  - -
    Pick a Date
  •  
  • Should be Empty: