Pre-Appointment Screening Form Please complete the following pre-appointment screening form before your appointment. Have you traveled in the past 14 days outside of the United States or Maryland? YesNo Have you experienced any fever, cough, flu-like symptoms or a loss of taste or smell in the last 10-14 days? YesNo Have you had direct contact with anyone that has tested positive for COVID-19 in the last 10-14 days? Have you had direct contact with anyone experiencing flu-like symptoms in the last 10-14 days? YesNo Have you attended any large group functions of more than 10 people? YesNo I understand and agree to follow the policies in place due to COVID-19 mentioned above.