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

    YesNo

    4. 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 questions 2-4, please call your practitioner before scheduled appointment as it may need to be rescheduled.

    Procedure upon arriving at Crossings

    1. Face coverings must be worn within Crossings space. Coverings must be securely fastened around top of nose and closed at sides of face. Masks that are lax or insecurely fit do not protect our practitioners or subsequent visitors. Please note, these face coverings are not acceptable:
    - Gator necks
    - Bandanas
    - Cloth or paper masks that have not been cleaned or worn too long.

    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.

    3. Flow of traffic through the hallways will continue to be entrance at front door and exit at back door. Arrows will indicate the flow 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.

    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