Infectious Disease Screening Questionnaire

The following is the Infectious Disease Screen Questionnaire.  Please understand this screening is being done for the safety of our patients and our staff. 

 Have you or anyone you are in close contact with traveled outside the country in the past 30 days? Yes/No

  • If yes, where: ____________________________

Are you currently experiencing any of the following? 

  • Fever greater than 101.5     Yes/No                                                 
  • Cough / Congestion / Respiratory illness   Yes/No                          
  • Shortness of breath    Yes/No                                                    
  • Fatigue   Yes/No                                                                          

If you answered "Yes" to any of these questions, you may request a video visit with your doctor.  Learn more about Orthopedic Associates of Port Huron's Telehealth options now.