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.

Have you had symptoms of respiratory illness (fever, sore throat, cough, shortness of breath)?
Yes No

Have you recently traveled?
Yes No

If yes, where and when?

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