COVID-19, AAMAA

Welcome To The Admission process

Start with the Covid-19 screening form. This form will need to be updated each time you are scheduled.

Covid-19 Screening Form

COVID-19 has been declared a worldwide pandemic by the World Health Organization.

COVID-19 has effected all our lives. New Regulations have made it necessary to take extra precautions and vigilance when screening, educating, and treating patients. Here at AAMAA we have taken every precaution to ensure the lowest risk and highest level of safety with regards to patient care and protection. Visitation to one of our facilities is by appointment and is done pre-scheduling/ pre-screening online though this website. All Patients and AAMAA employees are expected to wear a mask while in our facilities, cleanse their hands before and after contacting people or high touched surfaces and will be encouraged to maintain social distancing when feasible. The following form is the initial step in the screening and scheduling process. Please fill out the information and you will be directed to the scheduling forms afterwards. All patients will need to submit this form each and every time you are scheduled for an appointment at one of our facilities. Thank you for you understanding and cooperation as we try to make it as safe as possible during this pandemic.

Covid-19 Screening Form

My Current Temperature is less than 100.1 degrees Fahrenheit. *

Less than 100.1
Over 100.1

My temperature has not been above 100.1°F in the past 2 weeks. *

My temperature has been less than 100.1 for the last 2 weeks
My temperature has exceeded 100.1 at least once in the last 2 weeks

I have not knowingly been in contact with anyone diagnosed or suspected to have Covid-19 in the past 2 weeks. *

Type your initials

I have not had any of the following symptoms in the past 2 weeks: Fever, Cough, Sore Throat, Shortness of Breath, Persistent Chest Pain or Pressure, Unexplained Body Aches associated with a Cold, Flu or Illness. *

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In the event I contract Covid-19 in the next 2 weeks, I will notify my AAMA staff as soon as possible. *

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I acknowledge I am receiving Medical Services knowing that social distancing cannot be adhered to at all times and personal contact is unavoidably necessary at times during my procedure. *

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COVID-19 has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact as well as airborne transmission. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing. Your AAMAA staff member has put in place preventative measures to help reduce the spread of COVID-19; however, your AAMAA cannot guarantee that you will not become infected with COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by receiving services and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my treatment, service or appointment. On my behalf I hereby release, covenant not to sue, discharge, and hold harmless AAMAA staff members, the AAMAA facility, and any interested parties from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of my AAMAA staff member or the establishment where these services are received, whether a COVID-19 infection occurs before, during, or after participation in any medical treatment session. By typing your full legal name below you accept and acknowledge the terms and conditions setforth in this agreement. *

First

Last

Type your full legal name