Covid-19 Screening

Please Fill the following form
Have you had contact with someone who was diagnosed with COVID-19?
Live in or visit a place where COVID-19 is spreading?

Are you experiencing any of these symptoms?

Are you having shortness of breath?
Do you have or have you felt hot or feverish in the last two days?
Do you have a cough?

Your Signature

CONTACT US

Main Office

21150 Biscayne Blvd. Suite #208

Aventura, FL 33180

info@pulmonary-institute.com

Tel: 954-482-4747

Fax: 954-301-5939