Pre-Visit Family Screening Questions

Screening Questions, prior to every in-person visit

Please limit the number of people present during our session to you and your child whenever possible.  A second parent or caregiver may be present; however, we ask that there not be additional guests or visitors. We understand that there may be times when siblings will be present.

All In-Person Visits:

If yes response to any question in the box below, a telehealth visit will take place rather than in-person:

  • Are you or anyone in your home awaiting the results of a COVID-19 test that was recommended by a healthcare provider or health authority?
  • Is anyone in your home currently in isolation or quarantine, due to COVID-19 or COVID-19 exposure, per the recommendation of a healthcare provider or health authority?
  • With regard to health, have you or anyone in your home experienced any of the following COVID-19 related symptoms in the past 24 hours?
      • High temperature/fever equal to or greater than 100.3 degrees and/or feeling feverish?
      • Respiratory symptoms, including: shortness of breath, sore throat/runny nose/congestion not consistent with allergies?
      • Headache (that is atypical or without a known cause)?
      • Chills or muscle/body aches?
      • New or unexplained cough?
      • Gastrointestinal (GI) issues, such as diarrhea, vomiting or nausea?
      • New loss of taste or smell?
  • In adherence with State and CDC recommendations, if you are isolating or quarantining after travel, you may schedule a telehealth visit instead of an in-person session.

  • During today’s visit, will anyone, child or adult, with a weakened immune system, over 65 years of age, or with a chronic health condition be present? (The intent of this question is to open up a dialogue which covers the fact that certain persons are considered to be in a higher risk category and the family must decide- based on the information available- how to best proceed with this upcoming visit.)
  • Is there any other reason you think this appointment should be rescheduled?

Thank you for your time and patience in answering these questions. Screening questions are also being asked of our employees before they provide in-person services, as well. We are doing all that we can to ensure a safe and productive visit for you and your child/ren.