Visitors - The Anderson Nursing & Rehabilitation

COVID-19 Visitor Sign-in Form

Welcome to The Anderson! For the safety of our residents and staff please fill out the following COVID-19 Screening form:

Name *

First

Last

Date of Birth *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Temperature *

I certify that I do not have any COVID-19 Symptoms.

Symptoms Include: Fever or chills, Cough, Shortness of breath or difficulty breathing, Fatigue Muscle or body aches Headache, New loss of taste or smell, Sore throat, Congestion or runny nose, Nausea or vomiting and Diarrhea