Are you feeling ill or do you have any
COVID-19 or Flu like symptoms
such as:
fever, chills, cough, shortness of breath or difficulty breathing,
fatigue, muscle or body aches,
headache,
new loss of taste or smell, sore throat, congestion or runny nose,
nausea or vomiting, or diarrhea?
Yes
No
In the past 14 days, have you traveled
to a restricted state,
territory, or
country; or had close contact with someone with a lab confirmed case
of COVID-19?
If yes, you are advised to self-quarantine for 14 days per recommendation of the Center for
Disease Control (CDC) and the New York State Department of Health. Please schedule your
appointment outside the recommended 14-day window. Click
here for list of state/territories with restricted NYS COVID-19 Travel Advisory.
Yes
No
Since you have traveled and/or been in close contact with a confirmed
COVID-19 case, please select "yes"
to
attest that you will schedule your appointment outside of the 14 days
quarantine window.
