Betsy Gordon, LAcCOVID-19 Pre-Screening Survey
Updated 9/15/21
You'll receive an automated email 36 hours prior to your appointment which prompts you to complete the brief survey below.
Read about my updated procedures and precautions here. I welcome you to contact me with any questions!
In the last two weeks, have you ...
1. ... had contact with anyone with respiratory illness or a confirmed or probable case of COVID-19?*
- Yes
- No
If yes, please contact me at (971) 341-9546 or betsygordon.LAC@gmail.com. I may choose to reschedule your appointment but you won't be charged a fee.
2. ... experienced any of the following symptoms? (* - not related to a pre-existing condition)*
- New cough*
- New shortness of breath*
- Difficulty breathing
- New fever, or feeling feverish
- New chills, or repeated shaking with chills
- New fatigue*
- New body aches or muscle pain not caused by a specific activity such as exercise
- New diarrhea*
- New nasal congestion*
- New sore throat*
- New loss of taste or smell
- I have not experienced any of these symptoms.
If you select present symptoms, please contact me at (971) 341-9546 or betsygordon.LAC@gmail.com. I may choose to reschedule your appointment but you won't be charged a fee.
3. Are you fully vaccinated against COVID-19?
- Yes
- No
4. If no, have you travelled outside of Oregon?
- Yes
- No
If yes, please contact me at (971) 341-9546 or betsygordon.LAC@gmail.com. I may choose to reschedule your appointment but you won't be charged a fee.