T: 242.677.KIDS/ 603-0388 | C: 242.820.5437 | E: kiddiatrixx@yahoo.com
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Home
Meet Our Doctors
Meet Dr. Remy
Meet Dr. Rahming-O’Neil
Services
Forms
PATIENT REGISTRATION FORM
PRENATAL CONSULTATION
COVID QUESTIONNAIRE
Our Office
Podcast
Meet Our Staff
Videos
Book an Appointment
COVID QUESTIONNAIRE
Thank you for connecting with us. We will respond to you shortly.
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COVID QUESTIONNAIRE
Thank you for taking the time to complete this simple questionnaire. We appreciate your cooperation and patience in helping to keep our patients and staff safe.
Have you travelled outside the Bahamas in the past 30 days?
Yes
No
Have you been in contact with anyone who has recently been tested positive for COVID-19?
Yes
No
Have you recently been tested for COVID-19
Yes
No
Have you been experiencing any of the following:
Fever
Yes
No
Cough
Yes
No
Sore throat
Yes
No
Difficulty breathing
Yes
No
Muscle aches
Yes
No
Name:
Date:
Signature
Submit
