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: 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
- Have you recently traveled?
If yes, where and when? Yes No - 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 - Are you or anyone you have been in close contact with currently waiting on COVID-19 test results? Yes No
