Covid 19 Prescreening Form

Prescreening is required for all client visits. In collaboration with best practices, and for the safety of all of us, please answer the following questions:



YesNo

YesNo

3. Are you at all symptomatic with dry cough, fever, unusual fatigue, shortness of
breath; or have at least two of the following: fever, chills, repeated shaking with chills,
new muscle pain or headache, sore throat, new loss of taste or smell?

YesNo

If you answer yes to any of the above, please call to reschedule

Procedure upon arriving at Crossings
1. Face coverings must be worn inside the building and within Crossings space.
2. We request your arrival be as close to your appointment as possible. Every effort will be made to escort you into treatment rooms promptly. At this time we cannot permit accompaniment of family members or aides. Should you need special consideration email your practitioner to help you find a pathway for a visit.
3. Social distancing will be required in the space at all times. Seating, if physically necessary, will be 6 feet apart. Arrows will indicate the flow of traffic through the hallways.

Payment Process: For safety we are initiating a more contactless system at front desk
1. Clients will pay before each visit. We request that credit card information be stored
in our encrypted scheduling software system so that on subsequent visits charges can be automatically made.
2. Please respect the shield at front desk to protect our employees.

Please type your name to indicate that you have read this document.


CrossingsCares Response to CoVid 19 and Black Lives Matter Resources can be foundHERE