VISITOR HEALTH SCREEN

Luther Oaks requests your help to reduce community risks to the spread of COVID-19. For the residents, team members, and other visiting family members and guests, please complete the following health screen questions.

The completion of this health screen is required by the Illinois Department of Public Health.
Before each scheduled visit, the completion of this health screen is mandatory before Luther Oaks is able to welcome scheduled guests onto the campus.

* All fields and answers are required:
 

How many visitors for this scheduled visit?
(If two, second visitor must also complete this form)

Select One:

In the last 14 days, have you experienced any of the following signs or symptoms of COVID-19?

Fever
Cough
Shortness of Breath
Sore Throat
Chills
Shaking with Chills
Muscle Pain
Headache
New Loss of Taste
New Loss of Smell
Fatigue
Congestion
Runny Nose
Nausea
Vomitting
Diarrhea

In the last 14 days, have you come in contact with anyone who has a confirmed case of COVID-19, is under investigation for COVID-19, or ill with respiratory illness?

Select One

In the last 14 days, have traveled anywhere with widespread, ongoing transmission of COVID-19?

Select One

In the last 14 days, have you been on a cruise ship or been in an airport?

Select One

Are you, or anyone in your party, 18 years old or younger?

Select One

Contact Us

Tel: (309) 557-8000

Address

601 Lutz Road,

Bloomington, Illinois 61704

PRIVACY POLICY
© Lutheran Life Communities

A 501(c)3 not-for-profit corporation

Empowering vibrant, grace-filled living

across all generations.

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