COVID-19 Patient Screening
COVID-19 Screening Form
If you answer “yes” to any of the below questions please contact the office immediately at 757-923-1060 Extension 7000 or Extension 7027
Have you experienced any of the following symptoms in the past 7 days:
Fever or chills?
Shortness of breath/difficulty breathing?
Muscle or body aches?
New loss of taste or smell?
Change in taste or smell?
Congestion or runny nose?
Nausea or vomiting?
Within the past 14 days, have you been in close contact (6 feet or closer for more than 15 minutes) with:
Anyone who is known to have CONFIRMED COVID-19?
Anyone who has any symptoms consistent with COVID-19?
Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19?
Have you been tested for COVID-19?
If you were tested for COVID-19, were you tested within the past four weeks?
Are you currently waiting on the results of a COVID-19 Test?
The mission of Western Tidewater Free Clinic is to provide high-quality, non-emergency health care to the residents of Western Tidewater who cannot otherwise afford it. Western Tidewater Free Clinic maintains a 501(c)3 non-profit status and gifts are tax deductible to the full extent of the law.
Monday - Thursday: 9am - 4pm
Friday: 9am - 1pm