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Pre-Visit Questionnaire
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Before we schedule your campus visit we ask that you complete the following pre-visit questionnaire for yourself and anyone visiting with you. For the safety of our staff and other visitors, If you are not able to answer NO to all the questions below we will ask that you schedule a
Virtual Visit
.
Have you traveled in the past 14 days to any areas that would require you to quarantine? (Please reference the KDHE list
here
)
Have you traveled in the past 14 days to any areas that would require you to quarantine? (Please reference the KDHE list
here
)
Yes
No
Have you received notice that you were in close contact of a confirmed COVID-19 patient?
Have you received notice that you were in close contact of a confirmed COVID-19 patient?
Yes
No
Have you been told by a public health agency you should self-quarantine?
Have you been told by a public health agency you should self-quarantine?
Yes
No
Have you been in contact with anyone else within the last 2 weeks with a fever, cough or shortness of breath?
Have you been in contact with anyone else within the last 2 weeks with a fever, cough or shortness of breath?
Yes
No
In the past 14 days, have you experienced any of the following symptoms?
Fever
Cough
Shortness of breath or Difficulty breathing
Chills
New muscle pain
Sore throat
Any other flu-like symptoms
New loss of taste or smell
Changes in vision or eye discharge
Gastro intestinal upset
In the past 14 days, have you experienced any of the following symptoms?
Fever
Cough
Shortness of breath or Difficulty breathing
Chills
New muscle pain
Sore throat
Any other flu-like symptoms
New loss of taste or smell
Changes in vision or eye discharge
Gastro intestinal upset
Yes
No
Since you answered YES to one or more of the questions above, we ask that you
schedule a virtual campus visit
.
We appreciate your understanding as we work to keep our campus safe.
Click here to schedule your visit today
Submit