Health Check – Covina Development Center

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Covina Development Center

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About Us
Services
Contact
- Contact Us
- Health Check
For Parents
Donations
Toggle website search

Before visiting, please feel out and submit the below form. Once submitted, please follow the directions after.

Name *

First

Last

Reason for visit: *

Tour
Volunteer
Therapy (include for whom below)
Other (specify briefly below)

1. In the past 2-14 days have you experienced (check all that apply):

Coughing
Shortness of breath or difficulty breathing
Fever
Chills or repeated shaking with chills
Muscle pain or headache
New loss of taste or smell
Sore Throat
Fatigue

2. Have you recently been in close contact with anyone who has exhibited any of the above symptoms? *

Yes
No

3. Have you recently been in contact with anyone who has tested positive for Covid-19? *

Yes
No

If the answer is yes to a combination of symptoms in questions 1, individuals should test for Covid or stay home for at least 10 days from when symptoms first started AND at least 3 days after fever has gone and respiratory symptoms improve. Individuals with only fever should stay home until they are fever free (without medication) for at least 24 hours.

If the answer is yes to question 2 or 3, individuals should test for Covid then need to be in quarantine until negative results arrive or for at least 14 days after the last contact with someone who has or is suspected to have COVID-19. See “What to do if I am Exposed FAQs” from the Los Angeles County of Public Health for more information.

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