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COVID-19 Coronavirus Patient Self-Assessment Tool

COVID-19 Coronavirus Patient Self-Assessment Tool

Texas Fertility Center (TFC) is committed to protecting the health and safety of our patients. As our country and our world deal with the novel coronavirus (COVID-19) pandemic, our team is taking measures to protect you. This includes asking you certain questions when you visit our office.

We appreciate you answering the following self-assessment questions each time you visit our office.

  1. Have you had symptoms of: fever, cough, shortness of breath, fatigue, muscle or body aches, headache, new loss of taste smell, sore throat, congestion, or runny nose, nausea or vomiting, diarrhea  Yes No
  2. Have you recently traveled?
    If yes, where and when?  Yes No
  3. Have you been in close contact with anyone known or suspected to have the COVID-19 coronavirus illness?
    Close contact is defined as within 6 feet or for 3 minutes or more. Yes No
  4. Are you or anyone you have been in close contact with currently waiting on COVID-19 test results?  Yes No